| Organization Name: | MEDICAL MALL SERVICES OF MARYLAND, LLC |
| NPI Number: | 1124398086 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES CLAYTON BARDWELL (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 3001 Hospital Dr Cheverly |
| State: | MD US |
| Postal Code: | 207851189 |
| Phone Number: | 2024594766 |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2012 |
| NPI Last Update Date: | 01/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |