Healthcare Provider Details

I. General information

NPI: 1629529714
Provider Name (Legal Business Name): NORTH BAY GERIATRIC HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRICE DR
ELKTON MD
21921-6731
US

IV. Provider business mailing address

322 E CECIL AVE
NORTH EAST MD
21901-4012
US

V. Phone/Fax

Practice location:
  • Phone: 410-287-3727
  • Fax: 410-287-2819
Mailing address:
  • Phone: 410-287-3727
  • Fax: 410-287-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEELMOHAN SACHDEV
Title or Position: MEMBER
Credential:
Phone: 410-287-3727