| NPI | 1588376388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY THOMAS Credentialing Manager 410-616-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2022-12-23 |