Healthcare Provider Details

I. General information

NPI: 1043200900
Provider Name (Legal Business Name): MARYLAND CENTER FOR DIGESTIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DEFENSE HWY
ANNAPOLIS MD
21401-7004
US

IV. Provider business mailing address

171 DEFENSE HWY
ANNAPOLIS MD
21401-7004
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-1524
  • Fax: 410-224-4960
Mailing address:
  • Phone: 410-571-1524
  • Fax: 410-224-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-571-1524