MEDICARE: QUALITY MEDICAL CARE, LLC

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	207R00000X	Internal Medicine Physician	D0051958	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	014N	OTHER	MD	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G62516	OTHER	MD	UPIN

General Provider Information

NPI Number	:	1265602346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY MEDICAL CARE, LLC

Provider Business Mailing Address
First Line	:	5450 KNOLL NORTH DR
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2373
Country	:	US
Telephone Number	:	410-964-4508
Fax Number	:	410-964-4578

Provider Business Practice Location Address
First Line	:	5450 KNOLL NORTH DR
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2373
Country	:	US
Telephone Number	:	410-964-4508
Fax Number	:	410-964-4578

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARIE-ALBERTE BOURSIQUOT
Credential	:	M.D.
Telephone Number	:	410-964-4508

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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Directions to “QUALITY MEDICAL CARE, LLC ” Practice Location

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