Healthcare Provider Details

I. General information

NPI: 1366986739
Provider Name (Legal Business Name): MARYLAND MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SANDPIPER CIR STE 100
NOTTINGHAM MD
21236-5028
US

IV. Provider business mailing address

8100 SANDPIPER CIR STE 100
NOTTINGHAM MD
21236-5028
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-8334
  • Fax:
Mailing address:
  • Phone: 410-529-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0034931
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0034931
License Number StateMD

VIII. Authorized Official

Name: DR. ANN C MORRILL
Title or Position: DIRECTOR, RESIDENT AGENT
Credential: M.D.
Phone: 410-529-8334