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General NPI Number Information
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NPI Number | 1124386065
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Entity Type | Organization
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Legal Business Name | ATLANTIC BONE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 04/29/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 4263 ELK CREEK DR
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City | SALISBURY
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State | MD
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Zip | 21804-2563
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Country | US
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Telephone | 410-422-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 4263 ELK CREEK DR
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City | SALISBURY
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State | MD
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Zip | 21804-2563
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Country | US
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Telephone | 410-422-4263
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK LAYSHOCK
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Credential |
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Telephone | 410-422-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R041641
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License Number State | MD
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