Healthcare Provider Details

I. General information

NPI: 1083615355
Provider Name (Legal Business Name): KAREN LOUISE MCCLURE C.R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN LOUISE BORZILLO C.R.N.P

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 RITCHIE HWY # A
SEVERNA PARK MD
21146-2911
US

IV. Provider business mailing address

800 COOL GLADE CT
MILLERSVILLE MD
21108-1731
US

V. Phone/Fax

Practice location:
  • Phone: 410-544-4600
  • Fax: 410-544-0997
Mailing address:
  • Phone: 410-987-0784
  • Fax: 410-987-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR066214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: