| Organization Name: | UPPER CROSSROADS MEDICAL GROUP |
| NPI Number: | 1104290261 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SALVACION GARIN LAZATIN (PHYSICIAN/PARTNER) |
| Mailing Address: | 2412 Baldwin Mill Rd Fallston |
| State: | MD US |
| Postal Code: | 21047 |
| Phone Number: | 4105579191 |
| Fax Number: | 4105579191 |
| NPI Enumeration Date: | 11/30/2015 |
| NPI Last Update Date: | 11/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |