Healthcare Provider Details

I. General information

NPI: 1679208227
Provider Name (Legal Business Name): HEALTHSCAPE ELIZABETH THOMAS MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 ROLAND AVE
BALTIMORE MD
21211-2018
US

IV. Provider business mailing address

9722 GROFFS MILL DR
OWINGS MILLS MD
21117-6341
US

V. Phone/Fax

Practice location:
  • Phone: 443-850-0693
  • Fax:
Mailing address:
  • Phone: 443-850-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH THOMAS
Title or Position: CEO
Credential:
Phone: 443-850-0069