Healthcare Provider Details

I. General information

NPI: 1033730262
Provider Name (Legal Business Name): MICHAEL VOLKER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD STE 210
HANOVER MD
21076-1941
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 220
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-551-0499
  • Fax:
Mailing address:
  • Phone: 410-729-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR195614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: