| NPI | 1912641341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI THOMPSON Cmo 410-493-3901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QD0000X Clinic/Center Dental | |
| 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) | |
| 347B00000X Bus | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2024-02-20 |