=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043910136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARFORD MOBILE MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 MORSE RD
-----------------------------------------------------
City | FOREST HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21050-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-243-9371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 MORSE RD
-----------------------------------------------------
City | FOREST HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21050-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-243-9371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE O NEWSOME
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 443-243-9371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------