Healthcare Provider Details

I. General information

NPI: 1245521038
Provider Name (Legal Business Name): MARYLAND MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E 2ND ST SUITE 102
FREDERICK MD
21701-5345
US

IV. Provider business mailing address

205 CENTER ST SUITE 302
MOUNT AIRY MD
21771-5443
US

V. Phone/Fax

Practice location:
  • Phone: 301-238-5167
  • Fax: 301-685-3819
Mailing address:
  • Phone: 301-238-5167
  • Fax: 301-685-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AHMED H HUDHUD
Title or Position: PRESIDENT
Credential:
Phone: 301-238-5167