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General NPI Number Information
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NPI Number | 1063230605
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Entity Type | Organization
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Legal Business Name | ATLANTIC GENERAL HOSPITAL CORPORATION
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 10614 RACETRACK RD UNIT 1
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City | BERLIN
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State | MD
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Zip | 21811-3383
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Country | US
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Telephone | 443-728-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 9733 HEALTHWAY DR
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City | BERLIN
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State | MD
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Zip | 21811-1156
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Country | US
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Telephone | 410-641-1100
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Fax |
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Authorized Official
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Title or Position | SVP, FINANCE/CFO OF TIDALHEALTH
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Name | STEPHANIE GARY
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Credential |
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Telephone | 410-912-6059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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