|
| |
|
6131 Shady Side Rd Shady Side MD 20764-9504 | |
| (410) 867-2200 | |
| (410) 867-1261 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 6131 Shady Side Rd, Shady Side, Maryland |
| Authorized Official Name and Position | Christina Varga (REVENUE CYCLE MANAGER) |
| Authorized Official Contact | 4108674700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
134 Owensville Rd West River MD 20778-9702 Ph: (410) 867-4700 | 6131 Shady Side Rd Shady Side MD 20764-9504 Ph: (410) 867-2200 |
| NPI Number | 1174019327 |
|---|---|
| Provider Enumeration Date | 07/10/2018 |
| Last Update Date | 01/02/2025 |
| Certification Date | 01/02/2025 |
| Medicare PECOS PAC ID | 0244229474 |
|---|---|
| Medicare Enrollment ID | O20180927001817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174019327 | NPI | - | NPPES |
| 97991100 | Medicaid | MD | |
| 1063914836 | Medicaid | MD | |
| 209002300 | Medicaid | MD | |
| 338427600 | Medicaid | MD | |
| 400629100 | Medicaid | MD | |
| 404482700 | Medicaid | MD | |
| 103559201 | Medicaid | MD | |
| 531981100 | Medicaid | MD |