Healthcare Provider Details

I. General information

NPI: 1659192623
Provider Name (Legal Business Name): ADFINITAS HEALTH PALLIATIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
GWYNN OAK MD
21207-6665
US

IV. Provider business mailing address

PO BOX 69231
BALTIMORE MD
21264-9231
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-292-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM DELBRUGGE
Title or Position: CFO
Credential:
Phone: 301-693-8707