Healthcare Provider Details

I. General information

NPI: 1205950656
Provider Name (Legal Business Name): MARYLAND NEUROLOGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY SUITE 212
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

11085 LITTLE PATUXENT PKWY SUITE 212
COLUMBIA MD
21044-2983
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-1212
  • Fax: 410-730-2812
Mailing address:
  • Phone: 410-730-1212
  • Fax: 410-730-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL GEARHART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-730-1212