MEDICARE: SPECIALIZED EDUCATION OF MD, INC.

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1578942306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED EDUCATION OF MD, INC.

Provider Business Mailing Address
First Line	:	385 OXFORD VALLEY RD
Second Line	:	SUITE 408
City	:	YARDLEY
State	:	PA
Zip	:	19067-7700
Country	:	US
Telephone Number	:	215-369-8699
Fax Number	:	215-369-8690

Provider Business Practice Location Address
First Line	:	5100 PHILADELPHIA WAY
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4412
Country	:	US
Telephone Number	:	301-429-6191
Fax Number	:	301-429-6194

Authorized Official
Title or Position	:	CEO
Name	:	DR. MICHAEL KAUFMAN
Credential	:	PH.D.
Telephone Number	:	215-369-8699

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	05/26/2015

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