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General NPI Number Information
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NPI Number | 1043297385
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Entity Type | Organization
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Legal Business Name | RETINA CENTER OF WESTERN MARYLAND
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 251 E BALTIMORE ST LOWER LEVEL
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City | HAGERSTOWN
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State | MD
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Zip | 21740-6144
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Country | US
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Telephone | 301-416-8600
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Fax | 301-416-8602
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Provider Business Mailing Address
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Address Line | 251 E BALTIMORE ST LOWER LEVEL
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City | HAGERSTOWN
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State | MD
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Zip | 21740-6144
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Country | US
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Telephone | 301-416-8600
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Fax | 301-416-8602
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Authorized Official
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Title or Position | CEO
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Name | DARA TASH
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Credential | MD
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Telephone | 301-416-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0052418
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License Number State | MD
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