| NPI | 1598556144 |
|---|---|
| Other Name | SHADY GROVE |
| Entity Type | Organization |
| Authorized Contact | KRYSTLE D BROWN Billing Manager 410-870-9380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-05-14 |