Healthcare Provider Details

I. General information

NPI: 1801391933
Provider Name (Legal Business Name): SOUTHERN MARYLAND NEPHROLOGY AND HYPERTENSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD STE 750
CLINTON MD
20735-2581
US

IV. Provider business mailing address

1612 MAUD LN
CROWNSVILLE MD
21032-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-2810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC ANTWI-DONKOR
Title or Position: OWNER
Credential: MD
Phone: 301-856-2810