Healthcare Provider Details

I. General information

NPI: 1346052628
Provider Name (Legal Business Name): CRH MD MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BAUGHMANS LN
FREDERICK MD
21702-4904
US

IV. Provider business mailing address

590 LANIER AVE W
FAYETTEVILLE GA
30214-1504
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1392
  • Fax:
Mailing address:
  • Phone: 678-688-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA LYNN MALIK ROE
Title or Position: PRESIDENT
Credential:
Phone: 678-504-6392