Healthcare Provider Details

I. General information

NPI: 1740574763
Provider Name (Legal Business Name): BRIGHTSEAT SPECIALIST CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 BRIGHTSEAT RD
LANDOVER MD
20785-4250
US

IV. Provider business mailing address

1827 BRIGHTSEAT RD
LANDOVER MD
20785-4250
US

V. Phone/Fax

Practice location:
  • Phone: 301-386-6090
  • Fax:
Mailing address:
  • Phone: 301-386-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRIE L BALLENGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-386-6090