| Medical Legacy Llc | |
|
5310 Old Court Rd Suite 305 Randallstown MD 21133-5243 | |
| (410) 655-7100 | |
| (410) 655-7917 |
| Full Name | Medical Legacy Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 5310 Old Court Rd, Randallstown, Maryland |
| Authorized Official Name and Position | Olutoyin A Okunoren (PRACTICE COORDINATOR) |
| Authorized Official Contact | 4106557100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Legacy Llc 5310 Old Court Rd Suite 305 Randallstown MA 21133 Ph: (410) 655-7100 | Medical Legacy Llc 5310 Old Court Rd Suite 305 Randallstown MD 21133-5243 Ph: (410) 655-7100 |
| NPI Number | 1114189453 |
|---|---|
| Provider Enumeration Date | 06/27/2008 |
| Last Update Date | 06/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114189453 | NPI | - | NPPES |
| 255951000 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0023724 (Maryland) | Primary |
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