| NPI | 1629392550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY STEPHEN MARGOLIS Doctor 410-484-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MD D08029) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2013-04-15 |