Healthcare Provider Details

I. General information

NPI: 1780654814
Provider Name (Legal Business Name): MEDICAL HEALTH GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S MOUNTAIN RD STE 100
JOPPA MD
21085-3236
US

IV. Provider business mailing address

1415 S MOUNTAIN RD STE 100
JOPPA MD
21085-3236
US

V. Phone/Fax

Practice location:
  • Phone: 410-369-1699
  • Fax: 410-369-1707
Mailing address:
  • Phone: 410-369-1699
  • Fax: 410-369-1707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH L WOLCOTT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 410-369-1700