Healthcare Provider Details

I. General information

NPI: 1982074001
Provider Name (Legal Business Name): CLINICAL ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 FAIRMOUNT AVE STE 100A
TOWSON MD
21286-5466
US

IV. Provider business mailing address

515 FAIRMOUNT AVE STE 400
TOWSON MD
21286-5466
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-1315
  • Fax:
Mailing address:
  • Phone: 410-494-1324
  • Fax: 410-494-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1063
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberA1063
License Number StateMD

VIII. Authorized Official

Name: FRAN WINGERTER
Title or Position: CEO
Credential:
Phone: 240-444-0295