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General NPI Number Information
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NPI Number | 1184767162
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Entity Type | Organization
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Legal Business Name | GREENRIDGE HEALTH PARTNERS
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 YORK RD BLDG A SUITE 100
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City | TIMONIUM
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State | MD
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Zip | 21093-6016
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Country | US
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Telephone | 410-821-9620
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Fax | 410-821-9624
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Provider Business Mailing Address
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Address Line | 1300 YORK ROAD BLDG A SUITE 100
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City | TIMONIUM
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State | MD
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Zip | 21093-6016
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Country | US
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Telephone | 410-821-9620
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Fax | 410-821-9624
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RICHARD LLOYD TRADER
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Credential | PA-C
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Telephone | 410-821-9620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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