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201 Ballard Ave Middle River MD 21220-3632 | |
(410) 686-3931 | |
(410) 686-3932 |
Full Name | |
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Speciality | Surgery |
Location | 201 Ballard Ave, Middle River, Maryland |
Authorized Official Name and Position | Suhas Madhiraju (VICE PRESIDENT) |
Authorized Official Contact | 4106863931 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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201 Ballard Ave Middle River MD 21220-3632 Ph: (410) 686-3931 | 201 Ballard Ave Middle River MD 21220-3632 Ph: (410) 686-3931 |
NPI Number | 1326153875 |
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Provider Enumeration Date | 08/21/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326153875 | NPI | - | NPPES |
KCE8 | Other | MD | BLUE CROSS/BLUE SHIELD |
R103 | Other | MD | BLUE CHOICE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
208600000X | Surgery | (* (Not Available)) | Primary |
Health Md Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12 Irondale St Ste 120, Middle River, MD 21220 Phone: 410-687-3924 Fax: 410-687-4195 | |
Sticks R Us Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1515 Martin Blvd Ste 108, Middle River, MD 21220 Phone: 800-354-8935 Fax: 443-231-6767 | |