Healthcare Provider Details

I. General information

NPI: 1528197258
Provider Name (Legal Business Name): PREMIER ORTHOPEDICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR SUITE N
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

3570 SAINT JOHNS LN
ELLICOTT CITY MD
21042-4020
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-0009
  • Fax: 301-695-8633
Mailing address:
  • Phone: 410-461-9500
  • Fax: 410-461-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MYRA BUSCH
Title or Position: PRACTICE COORDINATOR
Credential:
Phone: 410-461-9500