Healthcare Provider Details

I. General information

NPI: 1609243112
Provider Name (Legal Business Name): STATCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220A E JOPPA RD STE 109
TOWSON MD
21286-5816
US

IV. Provider business mailing address

1400 FRONT AVENUE SUITE 300
LUTHERVILLE MD
21093
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-0018
  • Fax: 410-296-4106
Mailing address:
  • Phone: 440-296-7190
  • Fax: 443-991-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SCOTT THEODORE BURGER
Title or Position: CHIEF MEDICAL OFFICER
Credential: D.O.
Phone: 410-296-7190