Healthcare Provider Details

I. General information

NPI: 1477635019
Provider Name (Legal Business Name): CAOST GUARD YARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HAWKINS POINT RD
CURTIS BAY MD
21226-1797
US

IV. Provider business mailing address

2401 HAWKINS POINT RD
CURTIS BAY MD
21226-1797
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-3183
  • Fax: 410-636-7868
Mailing address:
  • Phone: 410-636-3183
  • Fax: 410-636-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON E FULCHER
Title or Position: MEDICAL ADMINISTARTOR
Credential:
Phone: 410-636-3183