Healthcare Provider Details

I. General information

NPI: 1679382949
Provider Name (Legal Business Name): MNR INDUSTRIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 QUARRY LAKE DR
BALTIMORE MD
21209-3759
US

IV. Provider business mailing address

1505 E CHURCHVILLE RD
BEL AIR MD
21014-4742
US

V. Phone/Fax

Practice location:
  • Phone: 443-842-6238
  • Fax: 443-842-6239
Mailing address:
  • Phone: 410-420-6970
  • Fax: 410-420-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAVIANNA BOST
Title or Position: MANAGER OF CREDENTIALING
Credential:
Phone: 410-420-6970