Healthcare Provider Details

I. General information

NPI: 1164493482
Provider Name (Legal Business Name): MAIN STREET MED CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951A MOUNT HERMON RD
SALISBURY MD
21804-5105
US

IV. Provider business mailing address

951A MOUNT HERMON RD
SALISBURY MD
21804-5105
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2700
  • Fax: 410-548-2608
Mailing address:
  • Phone: 410-548-2700
  • Fax: 410-548-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM36690
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES ONEIL BURNS
Title or Position: MEDICAL DIRECTOR CO OWNER
Credential: DO
Phone: 410-548-2700