{
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"FirstLineMailingAddress": "202 COURSEVALL DR",
"SecondLineMailingAddress": "SUITE 107",
"MailingAddressCityName": "CENTREVILLE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-778-3300",
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"FirstLinePracticeLocationAddress": "100 BROWN ST",
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"PracticeLocationAddressCityName": "CHESTERTOWN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-778-3300",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/28/2011",
"LastUpdateDate": "02/28/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FORRESTER",
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"AuthorizedOfficialTitle": "DIRECTOR, PATIENT FINANCIAL SERVICE",
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"AuthorizedOfficialCredential": "CPAM, CHAM",
"AuthorizedOfficialTelephoneNumber": "410-810-5192",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "21D022037",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}