Healthcare Provider Details

I. General information

NPI: 1922246206
Provider Name (Legal Business Name): UNION HOSPITAL OF CECIL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 PULASKI HWY STE 100 PRINCIPIO HEALTH CENTER
PERRYVILLE MD
21903
US

IV. Provider business mailing address

PO BOX 190
ELKTON MD
21922-0190
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-4679
  • Fax: 410-620-3686
Mailing address:
  • Phone: 410-398-4679
  • Fax: 410-620-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUDY RIESEN
Title or Position: CORPORATE DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 410-398-4000