| |
14299 Benedictine Ln Ridgely MD 21660-1434 | |
(410) 634-2112 | |
(410) 634-1223 |
Full Name | |
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Speciality | Speech-language Pathologist |
Location | 14299 Benedictine Ln, Ridgely, Maryland |
Authorized Official Name and Position | Tammie Cornish (ASSISTANT CONTROLLER) |
Authorized Official Contact | 4106342112 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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14299 Benedictine Ln Ridgely MD 21660-1434 Ph: (410) 634-2112 | 14299 Benedictine Ln Ridgely MD 21660-1434 Ph: (410) 634-2112 |
NPI Number | 1790820579 |
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Provider Enumeration Date | 02/20/2007 |
Last Update Date | 04/15/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790820579 | NPI | - | NPPES |
541778300 | Medicaid | MD |