Healthcare Provider Details

I. General information

NPI: 1942044789
Provider Name (Legal Business Name): AFFILIATED SANTE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST STE 104
ELKTON MD
21921-5780
US

IV. Provider business mailing address

12200 TECH RD STE 330
SILVER SPRING MD
20904-1913
US

V. Phone/Fax

Practice location:
  • Phone: 410-463-4455
  • Fax:
Mailing address:
  • Phone: 301-572-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SAHM
Title or Position: BILLING MANAGER
Credential:
Phone: 301-572-6585