MEDICARE: MARYLANDE REGIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	257498	SC
2	163W00000X	Registered Nurse	RN703181	PA

General Provider Information

NPI Number	:	1245826692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYLANDE REGIS

Provider Business Mailing Address
First Line	:	401 GLENWOOD AVE
Second Line	:
City	:	EAST LANSDOWNE
State	:	PA
Zip	:	19050-2512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 GLENWOOD AVE
Second Line	:
City	:	EAST LANSDOWNE
State	:	PA
Zip	:	19050-2512
Country	:	US
Telephone Number	:	267-235-5089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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Directions to “ MARYLANDE REGIS ” Practice Location

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