Basic Information
| Provider Information | |||||||||
| NPI: | 1922137835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW MARYLAND KIDNEY STONE MANAGEMENT,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 W THIRD AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142971158 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Practice Location | |||||||||
| Address1: | 6115 FALLS ROAD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887992622 | ||||||||
| FaxNumber: | 4103774410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | RIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6142988150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | A1158 | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.