Healthcare Provider Details

I. General information

NPI: 1679278055
Provider Name (Legal Business Name): MICHAEL RYAN PERSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SHOREWAY DR STE 120
QUEENSTOWN MD
21658-1681
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 220
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-827-4001
  • Fax: 410-827-4333
Mailing address:
  • Phone: 410-729-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0107660
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: