Blackwater Medical Associates, Llc

NPI 1063722171 - Specialist - 174400000X

NPI Details
NPI 1063722171
Enumeration Date 10/08/2010
Last Updated 10/08/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name MARK MARK
Position PRESIDENT
Phone (410) 228-1068
Fax (410) 228-6338
Practice Location
408 BYRN ST
CAMBRIDGE MD, 21613-1910, US
Phone (410) 228-1068
Fax (410) 228-6338
Business Location
408 BYRN ST
CAMBRIDGE MD, 21613-1910, US
Phone (410) 228-1068
Fax (410) 228-6338
Toxanomy
Taxonomy Code 174400000X
License State Maryland
License Number D0080504
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According to our database, Blackwater Medical Associates, Llc NPI is 1063722171, taxonomy code is 174400000X and license number is D0080504, license state is located at Maryland. Blackwater Medical Associates, Llc physically located at 408 Byrn St, Cambridge MD, 21613-1910. NPI Number 1033115704 has the healthcare provider type.

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1063722171 NPI number is provided on an as is basis without warranty of any kind. 1063722171 is maintained by the National Plan & Provider Enumeration System. The contents of Blackwater Medical Associates, Llc are for informational purposes only.