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General NPI Number Information
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NPI Number | 1013199298
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Entity Type | Organization
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Legal Business Name | LOURDES BRIGIDA HUNTER
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 201 THOMAS JOHNSON DR SUITE 104
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City | FREDERICK
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State | MD
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Zip | 21702-5166
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Country | US
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Telephone | 301-360-0776
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Fax | 301-631-8443
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Provider Business Mailing Address
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Address Line | 201 THOMAS JOHNSON DR SUITE 104
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City | FREDERICK
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State | MD
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Zip | 21702-5166
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Country | US
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Telephone | 301-360-0776
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Fax | 301-631-8443
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. JASON KENT HUNTER
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Credential |
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Telephone | 301-360-0776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D0062957
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License Number State | MD
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