Healthcare Provider Details

I. General information

NPI: 1619245289
Provider Name (Legal Business Name): MONOCACY HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
UNION BRIDGE MD
21791-9102
US

IV. Provider business mailing address

PO BOX 1110
UNION BRIDGE MD
21791-1110
US

V. Phone/Fax

Practice location:
  • Phone: 410-775-2622
  • Fax: 410-775-2050
Mailing address:
  • Phone: 410-775-2622
  • Fax: 410-775-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE K MAHAN
Title or Position: SR VP AND CFO
Credential:
Phone: 240-566-3355