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General NPI Number Information
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NPI Number | 1154119972
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Entity Type | Organization
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Legal Business Name | SUMMIT RESTORATIVE HEALTH, LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 10375 NETTLE PL
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City | NEWBURG
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State | MD
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Zip | 20664-2408
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Country | US
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Telephone | 443-336-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 10375 NETTLE PL
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City | NEWBURG
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State | MD
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Zip | 20664-2408
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Country | US
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Telephone | 443-336-2808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGHAN NICOLE BYNUM
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Credential | NP
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Telephone | 443-336-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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