Healthcare Provider Details

I. General information

NPI: 1104536283
Provider Name (Legal Business Name): BTA MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 GRANDE VIEW AVE
SEVERN MD
21144-3333
US

IV. Provider business mailing address

1778 GRANDE VIEW AVE
SEVERN MD
21144-3333
US

V. Phone/Fax

Practice location:
  • Phone: 240-501-8616
  • Fax:
Mailing address:
  • Phone: 240-501-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABIMBOLA HILLARD
Title or Position: PROVIDER
Credential:
Phone: 240-501-8616