Healthcare Provider Details

I. General information

NPI: 1063692291
Provider Name (Legal Business Name): PATUXENT RHEUMATOLOGY ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 N. PRINCE FREDERICK BLVD SUITE 103
PRINCE FREDERICK MD
20678-3151
US

IV. Provider business mailing address

PO BOX 424
PRINCE FREDERICK MD
20678-0424
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-3437
  • Fax: 410-414-3451
Mailing address:
  • Phone: 410-414-3437
  • Fax: 410-414-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0059442
License Number StateMD

VIII. Authorized Official

Name: DR. ASHA GEORGE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-414-3437