Healthcare Provider Details

I. General information

NPI: 1891086203
Provider Name (Legal Business Name): CVM-PRINCE FREDERICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STEEPLE CHASE DR SUITE 203
PRINCE FREDERICK MD
20678-4049
US

IV. Provider business mailing address

12200 ANNAPOLIS RD SUITE 225
GLENN DALE MD
20769-9182
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-9282
  • Fax:
Mailing address:
  • Phone: 301-860-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. ARUNA THAPAR
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 301-860-0003