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General NPI Number Information
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NPI Number | 1164696647
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Entity Type | Organization
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Legal Business Name | OB GYN & ENDOSCOPY OF CARROLL COUNTY, LLC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1380 PROGRESS WAY STE 107
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City | ELDERSBURG
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State | MD
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Zip | 21784-6498
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Country | US
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Telephone | 410-876-7049
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Fax | 410-795-7054
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Provider Business Mailing Address
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Address Line | 1380 PROGRESS WAY STE 107
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City | ELDERSBURG
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State | MD
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Zip | 21784-6498
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Country | US
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Telephone | 410-876-7049
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Fax | 410-795-7054
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Authorized Official
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Title or Position | OFFICER
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Name | DR. MICHAEL VIETZ
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Credential | M.D.
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Telephone | 410-876-7049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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