Healthcare Provider Details

I. General information

NPI: 1063147395
Provider Name (Legal Business Name): MARYLAND ELDER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 DAVIDSONVILLE RD
CROFTON MD
21114-1632
US

IV. Provider business mailing address

542 FAIRMOUNT RD
LINTHICUM MD
21090-2842
US

V. Phone/Fax

Practice location:
  • Phone: 410-507-7617
  • Fax:
Mailing address:
  • Phone: 410-995-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGAN GREY
Title or Position: OWNER
Credential: CRNP
Phone: 410-995-7439