Healthcare Provider Details

I. General information

NPI: 1164937868
Provider Name (Legal Business Name): RICHARD FREDERICK QUARTERMAIN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 STILL MEADOW BLVD STE B124
SALISBURY MD
21804-7511
US

IV. Provider business mailing address

10 BRUSH ISLAND CT
BERLIN MD
21811-3344
US

V. Phone/Fax

Practice location:
  • Phone: 410-219-5088
  • Fax:
Mailing address:
  • Phone: 402-371-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02791
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: