| NPI | 1992824486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN J WAGENHEIM Practice Administrator 410-922-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2025-09-11 |