Healthcare Provider Details

I. General information

NPI: 1407607450
Provider Name (Legal Business Name): UNION HOSPITAL OF CECIL COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W HIGH ST STE 2B
ELKTON MD
21921-8615
US

IV. Provider business mailing address

207 NORTH ST
ELKTON MD
21921-5512
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0451
  • Fax:
Mailing address:
  • Phone: 410-398-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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