Healthcare Provider Details

I. General information

NPI: 1912130972
Provider Name (Legal Business Name): ST. MICHAELS SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SEYMOUR AVE
ST MICHAELS MD
21663-2932
US

IV. Provider business mailing address

100 S HANSON ST
EASTON MD
21601-2920
US

V. Phone/Fax

Practice location:
  • Phone: 410-819-5600
  • Fax:
Mailing address:
  • Phone: 410-819-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORIA DILL
Title or Position: DEPUTY HEALTH OFFICER
Credential:
Phone: 410-819-5600