Healthcare Provider Details

I. General information

NPI: 1255417200
Provider Name (Legal Business Name): MARYLAND INPATIENT CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PARKWAY
ANNAPOLIS MD
21236
US

IV. Provider business mailing address

9900B FRANKLIN SQUARE DRIVE
BALTIMORE MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 301-651-2749
  • Fax:
Mailing address:
  • Phone: 410-931-0400
  • Fax: 410-931-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS MITCHELL
Title or Position: OWNER
Credential: M.D.
Phone: 301-651-2749