Healthcare Provider Details

I. General information

NPI: 1740919836
Provider Name (Legal Business Name): ATLANTIC RECOVERY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S DIVISION ST
SALISBURY MD
21801-4930
US

IV. Provider business mailing address

205 S DIVISION ST
SALISBURY MD
21801-4930
US

V. Phone/Fax

Practice location:
  • Phone: 443-944-9896
  • Fax:
Mailing address:
  • Phone: 443-978-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS BORODULIA
Title or Position: MD
Credential: MD
Phone: 410-430-5154