Healthcare Provider Details

I. General information

NPI: 1881431815
Provider Name (Legal Business Name): DONTAY ROY LEE SAUNDERS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DONTAY ROY LEE SAUNDERS LMT

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 BRANCH AVE.
TEMPLE HILLS MD
20748
US

IV. Provider business mailing address

821 CHESAPEAKE AVE. #4158
ANNAPOLIS MD
21403-3285
US

V. Phone/Fax

Practice location:
  • Phone: 301-316-2111
  • Fax: 301-316-5382
Mailing address:
  • Phone: 443-254-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM06655
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: