Healthcare Provider Details

I. General information

NPI: 1083654479
Provider Name (Legal Business Name): FIVE STAR PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 ELKRIDGE LANDING RD STE 300
LINTHICUM HEIGHTS MD
21090-2958
US

IV. Provider business mailing address

P.O. BOX 2613
SALISBURY MD
21802-2613
US

V. Phone/Fax

Practice location:
  • Phone: 443-548-5700
  • Fax: 443-548-5705
Mailing address:
  • Phone: 443-548-5700
  • Fax: 443-548-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. RACHEL SETTING
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 410-279-0317