| Advanced Total Health Clinic Llc | |
|
8305 Liberty Rd Baltimore MD 21244-3125 | |
| (410) 922-4341 | |
| Not Available |
| Full Name | Advanced Total Health Clinic Llc |
|---|---|
| Speciality | General Practice |
| Location | 8305 Liberty Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Jinho Ahn (EMPLOYEE) |
| Authorized Official Contact | 2132191915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Total Health Clinic Llc 8305 Liberty Rd Baltimore MD 21244-3125 Ph: (410) 922-4341 | Advanced Total Health Clinic Llc 8305 Liberty Rd Baltimore MD 21244-3125 Ph: (410) 922-4341 |
| NPI Number | 1518505056 |
|---|---|
| Provider Enumeration Date | 12/16/2019 |
| Last Update Date | 12/16/2019 |
| Medicare PECOS PAC ID | 7012345119 |
|---|---|
| Medicare Enrollment ID | O20200324002905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518505056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Eboni G Mccoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326552860 PECOS PAC ID: 7113289083 Enrollment ID: I20200403001041 |
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