Healthcare Provider Details

I. General information

NPI: 1174380679
Provider Name (Legal Business Name): MXJ HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 FALLS RD
BALTIMORE MD
21211-1844
US

IV. Provider business mailing address

2368 FLAX TER
BALTIMORE MD
21209-4624
US

V. Phone/Fax

Practice location:
  • Phone: 443-414-9573
  • Fax:
Mailing address:
  • Phone: 443-414-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MALCOLM JEFFERIES
Title or Position: OWNER
Credential:
Phone: 443-414-9573