Organization Name: | INJURY TREATMENT CENTER OF MARYLAND,LLC |
NPI Number: | 1992824486 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EVAN J WAGENHEIM (PRACTICE ADMINISTRATOR) |
Mailing Address: | 8660 Liberty Rd Randallstown |
State: | MD US |
Postal Code: | 211334707 |
Phone Number: | 4109222300 |
Fax Number: | |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |