Healthcare Provider Details

I. General information

NPI: 1053926741
Provider Name (Legal Business Name): PASS MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 LANDMARK CT
ESSEX MD
21221-3042
US

IV. Provider business mailing address

64 LANDMARK CT
ESSEX MD
21221-3042
US

V. Phone/Fax

Practice location:
  • Phone: 443-470-6041
  • Fax:
Mailing address:
  • Phone: 443-470-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTORIA LEE
Title or Position: CLIENT SERVICE DIRECTOR
Credential:
Phone: 443-470-6041