Healthcare Provider Details

I. General information

NPI: 1780853325
Provider Name (Legal Business Name): SHORE PSYCHIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 TEAL DR SUITE 406
EASTON MD
21601-7227
US

IV. Provider business mailing address

8221 TEAL DR SUITE 406
EASTON MD
21601-7227
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-4005
  • Fax: 410-820-4008
Mailing address:
  • Phone: 410-820-4005
  • Fax: 410-820-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberD0040200
License Number StateMD

VIII. Authorized Official

Name: DR. ALLAN ARTHUR ANDERSON
Title or Position: DOCTOR
Credential: M.D.
Phone: 410-820-4005