Healthcare Provider Details

I. General information

NPI: 1013010198
Provider Name (Legal Business Name): DAMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 BUTTERCUP CT
BERLIN MD
21811
US

IV. Provider business mailing address

P.O. BOX 2497
SALISBURY MD
21802-2497
US

V. Phone/Fax

Practice location:
  • Phone: 410-713-2353
  • Fax:
Mailing address:
  • Phone: 443-260-2660
  • Fax: 443-260-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000410
License Number StateDE

VIII. Authorized Official

Name: MRS. MARY ELIZABETH BERNAL-CLARK
Title or Position: CRNP
Credential: APRN,BC
Phone: 410-641-1117