Healthcare Provider Details

I. General information

NPI: 1851622401
Provider Name (Legal Business Name): US COAST GUARD YARD - HSWL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HAWKINS POINT RD BLDG 28B
BALTIMORE MD
21226
US

IV. Provider business mailing address

2401 HAWKINS POINT RD BLDG 28B
BALTIMORE MD
21226
US

V. Phone/Fax

Practice location:
  • Phone: 410-626-7506
  • Fax: 410-626-7868
Mailing address:
  • Phone: 410-626-7506
  • Fax: 410-626-7868

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: HAROLD E. SCHOFIELD
Title or Position: HSC
Credential:
Phone: 410-636-7506