Healthcare Provider Details

I. General information

NPI: 1407199334
Provider Name (Legal Business Name): ANNAPOLIS HAND CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 NORTHVIEW DR SUITE 101
BOWIE MD
20716-2604
US

IV. Provider business mailing address

128 LUBRANO DR SUITE 301
ANNAPOLIS MD
21401-7028
US

V. Phone/Fax

Practice location:
  • Phone: 410-544-4263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberD0064806
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number05154
License Number StateMD

VIII. Authorized Official

Name: THOMAS DENNIS
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 510-544-4263