Basic Information
| Provider Information | |||||||||
| NPI: | 1730541079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR MEDICAL CENTER & URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | OXON HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207451597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015679100 | ||||||||
| FaxNumber: | 2407125052 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | OXON HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207451597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015679100 | ||||||||
| FaxNumber: | 2407125052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 03/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | TEJAY | ||||||||
| AuthorizedOfficialFirstName: | RICHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 14105915212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0006044 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.