Healthcare Provider Details

I. General information

NPI: 1144697129
Provider Name (Legal Business Name): ISLAND MEDICAL HOSPITALIST CARLSBAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

12420 MILESTONE CENTER DR STE 200
GERMANTOWN MD
20876-7111
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax:
Mailing address:
  • Phone: 240-686-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY CARLEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 240-686-2300