Healthcare Provider Details

I. General information

NPI: 1922137835
Provider Name (Legal Business Name): NEW MARYLAND KIDNEY STONE MANAGEMENT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 FALLS ROAD
BALTIMORE MD
21209
US

IV. Provider business mailing address

100 W THIRD AVE STE 150
COLUMBUS OH
43201
US

V. Phone/Fax

Practice location:
  • Phone: 888-799-2622
  • Fax: 410-377-4410
Mailing address:
  • Phone: 614-297-1158
  • Fax: 614-299-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA1158
License Number State

VIII. Authorized Official

Name: MR. RIC HUGHES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 614-298-8150