Healthcare Provider Details

I. General information

NPI: 1831710805
Provider Name (Legal Business Name): MARK EDWARD DRISCOLL PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 QUAIL RUN DR
CENTREVILLE MD
21617-2301
US

IV. Provider business mailing address

212 QUAIL RUN DR
CENTREVILLE MD
21617-2301
US

V. Phone/Fax

Practice location:
  • Phone: 443-347-3677
  • Fax:
Mailing address:
  • Phone: 443-347-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0211285
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: