Healthcare Provider Details

I. General information

NPI: 1467789693
Provider Name (Legal Business Name): ANNE ARUNDEL MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST 213
CHESTER MD
21619-2791
US

IV. Provider business mailing address

PO BOX 64294
BALTIMORE MD
21264-4294
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-5300
  • Fax: 443-481-6705
Mailing address:
  • Phone: 443-481-6573
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN CLARKE
Title or Position: VP BUSINESS DEVELOPMENT
Credential:
Phone: 443-481-6464