Healthcare Provider Details

I. General information

NPI: 1861049959
Provider Name (Legal Business Name): MDF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S CHERRY GROVE AVE STE C
ANNAPOLIS MD
21401-4235
US

IV. Provider business mailing address

509 S CHERRY GROVE AVE STE C
ANNAPOLIS MD
21401-4235
US

V. Phone/Fax

Practice location:
  • Phone: 844-322-4222
  • Fax: 443-400-0509
Mailing address:
  • Phone: 844-322-4222
  • Fax: 443-400-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BOND
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 844-322-4222