Healthcare Provider Details

I. General information

NPI: 1043279300
Provider Name (Legal Business Name): THE RETINA CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 FALLS RD 300
BALTIMORE MD
21209-2219
US

IV. Provider business mailing address

6115 FALLS RD 300
BALTIMORE MD
21209-2219
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-7611
  • Fax: 410-377-8221
Mailing address:
  • Phone: 410-377-7611
  • Fax: 410-377-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0051444
License Number StateMD

VIII. Authorized Official

Name: ERIC P SUAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-377-7611