Healthcare Provider Details

I. General information

NPI: 1992420178
Provider Name (Legal Business Name): HARFORD GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALTER WARD BLVD STE 100
ABINGDON MD
21009-1283
US

IV. Provider business mailing address

100 WALTER WARD BLVD STE 100
ABINGDON MD
21009-1283
US

V. Phone/Fax

Practice location:
  • Phone: 443-347-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN STREETT
Title or Position: FNP
Credential:
Phone: 410-967-4543