| NPI | 1508295726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS J TRENTLY CFO 443-738-0281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0071154) |
| 207R00000X Internal Medicine (Licence: MD D53063) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R167803) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2021-02-03 |