Healthcare Provider Details

I. General information

NPI: 1154396422
Provider Name (Legal Business Name): ELIZABETH G SCHLENOFF MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MT CARMEL RD SUITE 4
PARKTON MD
21120-9750
US

IV. Provider business mailing address

214 MT CARMEL RD SUITE 4
PARKTON MD
21120-9750
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-5559
  • Fax: 410-357-0308
Mailing address:
  • Phone: 410-357-5559
  • Fax: 410-357-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD22557
License Number StateMD

VIII. Authorized Official

Name: ELIZABETH G SCHLENOFF JR.
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 410-357-5559