Basic Information
| Provider Information | |||||||||
| NPI: | 1194020792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC BONE HEALTH CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 AURORA ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102280556 | ||||||||
| FaxNumber: | 4102283986 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 AURORA ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102280556 | ||||||||
| FaxNumber: | 4102283986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | MACLAUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | EDMUND | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4102280556 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | D28209 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.