Healthcare Provider Details

I. General information

NPI: 1134437635
Provider Name (Legal Business Name): EMERGENCY MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVENUE CARROLL HOSPITAL CENTER
WESTMINSTER MD
21157
US

IV. Provider business mailing address

20010 CENTURY BLVD., SUITE 200 EMERGENCY MEDICINE ASSOCIATES
GERMANTOWN MD
20874
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-6700
  • Fax: 410-871-7177
Mailing address:
  • Phone: 240-686-2300
  • Fax: 240-686-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CHASTAIN
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 330-493-4443