Basic Information
Provider Information
NPI: 1740862010
EntityType: 2
ReplacementNPI:  
OrganizationName: MARYLAND GENERAL CLINICAL PRACTICE GROUP, INC.
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Mailing Information
Address1: 900 ELKRIDGE LANDING RD FL 2
Address2:  
City: LINTHICUM
State: MD
PostalCode: 210902924
CountryCode: US
TelephoneNumber: 4434625010
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Practice Location
Address1: 4801 LIBERTY HEIGHTS AVE
Address2:  
City: GWYNN OAK
State: MD
PostalCode: 212077157
CountryCode: US
TelephoneNumber: 4104682124
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Other Information
ProviderEnumerationDate: 04/26/2021
LastUpdateDate: 06/08/2022
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AuthorizedOfficialLastName: BROWN
AuthorizedOfficialFirstName: ALISON
AuthorizedOfficialMiddleName: GATES
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4102258614
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 06/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174H00000X  Y193400000X SINGLE SPECIALTY GROUPOther Service ProvidersHealth Educator 

No ID Information.


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