Healthcare Provider Details

I. General information

NPI: 1285123869
Provider Name (Legal Business Name): EASTSIDE MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732B E MAIN ST
SALISBURY MD
21804-5037
US

IV. Provider business mailing address

732B E MAIN ST
SALISBURY MD
21804-5037
US

V. Phone/Fax

Practice location:
  • Phone: 410-251-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: SYED JAFFERY
Title or Position: DIRECTOR
Credential: MD
Phone: 410-219-5200