Healthcare Provider Details

I. General information

NPI: 1154757326
Provider Name (Legal Business Name): HOWARD COUNTY CENTER FOR LUNG AND SLEEP MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PKWY 100
COLUMBIA MD
21044-3078
US

IV. Provider business mailing address

10910 LITTLE PATUXENT PKWY 100
COLUMBIA MD
21044-3078
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-3635
  • Fax: 410-740-1253
Mailing address:
  • Phone: 410-740-3635
  • Fax: 410-740-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA A NYANJOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-740-3635