| NPI | 1871973628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEWEL WATSON Credentialing Coordinator 410-494-1237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 363A00000X Physician Assistant | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2026-04-07 |