Organization Name: | STATCARE GROUP II, PC |
NPI Number: | 1558726141 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACQUELINE ANGELA CARTER (CREDENTIALING & PROVIDER ENROLLMENT) |
Mailing Address: | 2315 Bel Air Rd Fallston |
State: | MD US |
Postal Code: | 210472740 |
Phone Number: | 4102967190 |
Fax Number: | 4102960344 |
NPI Enumeration Date: | 12/23/2015 |
NPI Last Update Date: | 01/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | H0062737 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |