Healthcare Provider Details

I. General information

NPI: 1144071945
Provider Name (Legal Business Name): UNION HOSPITAL OF CECIL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W HIGH ST STE 207
ELKTON MD
21921-8611
US

IV. Provider business mailing address

207 NORTH ST
ELKTON MD
21921-5512
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-2436
  • Fax:
Mailing address:
  • Phone: 410-398-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUDY RIESEN
Title or Position: CORPORATE DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 302-623-7168