Healthcare Provider Details

I. General information

NPI: 1033959937
Provider Name (Legal Business Name): MARYLAND ELDER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 WAUGH CHAPEL RD
GAMBRILLS MD
21054-1608
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-2020
  • Fax:
Mailing address:
  • Phone: 224-777-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGAN GREY
Title or Position: PRESIDENT
Credential: CRNP
Phone: 410-507-7617