| Maryland Healing Waters, Llc | |
|
1414 Crain Hwy N Ste 6a Glen Burnie MD 21061-9307 | |
| (410) 761-7901 | |
| (410) 761-1031 |
| Full Name | Maryland Healing Waters, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1414 Crain Hwy N Ste 6a, Glen Burnie, Maryland |
| Authorized Official Name and Position | Lawrence Vidaver (PHYSICIAN) |
| Authorized Official Contact | 4107617901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryland Healing Waters, Llc 1414 Crain Hwy N Ste 6a Glen Burnie MD 21061-9307 Ph: (410) 761-7901 | Maryland Healing Waters, Llc 1414 Crain Hwy N Ste 6a Glen Burnie MD 21061-9307 Ph: (410) 761-7901 |
| NPI Number | 1366739179 |
|---|---|
| Provider Enumeration Date | 06/30/2011 |
| Last Update Date | 05/17/2024 |
| Medicare PECOS PAC ID | 4789853169 |
|---|---|
| Medicare Enrollment ID | O20110802000355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366739179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D25559 (Maryland) | Primary |
| Provider Name | Lawrence Vidaver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578778585 PECOS PAC ID: 9436328713 Enrollment ID: I20110802000496 |
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