Basic Information
| Provider Information | |||||||||
| NPI: | 1821582297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXPANDING MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 973 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211580973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108485785 | ||||||||
| FaxNumber: | 4108485629 | ||||||||
| Practice Location | |||||||||
| Address1: | 7309 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217847531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107951100 | ||||||||
| FaxNumber: | 4108485629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | WAH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6673672260 | ||||||||
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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 | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.