Organization Name: | PREMIERE CHILDRENS PHYSICANS, PA |
NPI Number: | 1235461039 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LESTER BYRON HORRELL (OWNER/PHYSICIAN) |
Mailing Address: | 701 N Bridge St Suite 104, Northside Plaza Elkton |
State: | MD US |
Postal Code: | 219215309 |
Phone Number: | 4103985930 |
Fax Number: | 4103980165 |
NPI Enumeration Date: | 02/03/2010 |
NPI Last Update Date: | 02/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | D0056952 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |