Healthcare Provider Details

I. General information

NPI: 1619975646
Provider Name (Legal Business Name): ENTAA CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

IV. Provider business mailing address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax: 410-760-8847
Mailing address:
  • Phone: 410-760-8840
  • Fax: 410-760-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC D HAMBURGER
Title or Position: PRESIDENT
Credential: M.D,
Phone: 410-760-8840