Healthcare Provider Details

I. General information

NPI: 1902175870
Provider Name (Legal Business Name): MEDSTAR URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 YORK RD
BALTIMORE MD
21212-2359
US

IV. Provider business mailing address

6317 YORK RD
BALTIMORE MD
21212-2359
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6890
  • Fax: 410-433-2015
Mailing address:
  • Phone: 443-777-6890
  • Fax: 410-433-2015

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: MS. ARLENE BREWSTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 410-933-3017