Healthcare Provider Details

I. General information

NPI: 1538095591
Provider Name (Legal Business Name): BLACK ROCK INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 INDUSTRY LN STE 125
FREDERICK MD
21704-5163
US

IV. Provider business mailing address

120 N POTOMAC ST
HAGERSTOWN MD
21740-4810
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-4938
  • Fax: 866-441-1174
Mailing address:
  • Phone: 301-790-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHERI LYNN DENHAM
Title or Position: OWNER
Credential:
Phone: 301-790-4938