Healthcare Provider Details

I. General information

NPI: 1841479938
Provider Name (Legal Business Name): DRS BIONDO & SIM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LEWIS LANE SUITE 201
HAVRE DE GRACE MD
21078-3753
US

IV. Provider business mailing address

251 LEWIS LN SUITE 201
HAVRE DE GRACE MD
21078-3751
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-4477
  • Fax: 410-939-1153
Mailing address:
  • Phone: 410-939-4477
  • Fax: 410-939-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA M GALLION
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-939-4477