Healthcare Provider Details

I. General information

NPI: 1306272869
Provider Name (Legal Business Name): DORSAM & GENERIE, OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 OLD DOBBIN LN STE 190
COLUMBIA MD
21045-5954
US

IV. Provider business mailing address

5725 RICHARDS VALLEY RD STE A9
ELLICOTT CITY MD
21043-6964
US

V. Phone/Fax

Practice location:
  • Phone: 443-420-8113
  • Fax: 443-973-6998
Mailing address:
  • Phone: 443-420-8113
  • Fax: 443-420-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1997
License Number StateMD

VIII. Authorized Official

Name: DR. CHRISTINA GENERIE
Title or Position: CO-OWNER
Credential: O.D.
Phone: 443-420-8113