Healthcare Provider Details

I. General information

NPI: 1811228422
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HAWKINS POINT RD
BALTIMORE MD
21226-1797
US

IV. Provider business mailing address

2401 HAWKINS POINT RD
BALTIMORE MD
21226-1797
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-7506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JILLYNDA WILLIAMS
Title or Position: HSC
Credential:
Phone: 410-636-7506