=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073490264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEF DEVELOPMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13214 FOUNTAIN HEAD PLZ
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-2678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-766-9293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13214 FOUNTAIN HEAD PLZ
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-2678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-766-9293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OF OPERATIONS
-----------------------------------------------------
Name | SUSAN GLOSBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-766-9293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------