Healthcare Provider Details

I. General information

NPI: 1508166752
Provider Name (Legal Business Name): MOUNTAIN VIEW PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 FORD AVE
CUMBERLAND MD
21502-4612
US

IV. Provider business mailing address

1602 FORD AVE
CUMBERLAND MD
21502-4612
US

V. Phone/Fax

Practice location:
  • Phone: 301-759-4544
  • Fax: 301-723-4446
Mailing address:
  • Phone: 301-759-4544
  • Fax: 301-723-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberR087737
License Number StateMD

VIII. Authorized Official

Name: THOMAS ALAN BOSTAPH
Title or Position: PRESIDENT / OWNER
Credential: CRNP
Phone: 240-522-8250