Crofton Medical Group, Llc | |
1667 Crofton Ctr Suite 5 Crofton MD 21114-1303 | |
(410) 721-2700 | |
(410) 721-8874 |
Full Name | Crofton Medical Group, Llc |
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Speciality | Internal Medicine |
Location | 1667 Crofton Ctr, Crofton, Maryland |
Authorized Official Name and Position | Mirza M Nusairee (PRESIDENT) |
Authorized Official Contact | 4107212700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Crofton Medical Group, Llc 1667 Crofton Ctr Suite 5 Crofton MD 21114-1303 Ph: (410) 721-2700 | Crofton Medical Group, Llc 1667 Crofton Ctr Suite 5 Crofton MD 21114-1303 Ph: (410) 721-2700 |
NPI Number | 1457308090 |
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Provider Enumeration Date | 05/28/2006 |
Last Update Date | 05/12/2016 |
Medicare PECOS PAC ID | 8921065541 |
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Medicare Enrollment ID | O20041215000797 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457308090 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Mirza M Nusairee |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1043257256 PECOS PAC ID: 4688562143 Enrollment ID: I20040306000130 |
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