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General NPI Number Information
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NPI Number | 1245910579
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE PRIMARY CARE PRACTICE LLC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 7416 CHURCH HILL RD STE 2
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City | CHESTERTOWN
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State | MD
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Zip | 21620-2808
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Country | US
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Telephone | 410-498-4848
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Fax |
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Provider Business Mailing Address
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Address Line | 7416 CHURCH HILL RD STE 2
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City | CHESTERTOWN
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State | MD
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Zip | 21620-2808
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Country | US
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Telephone | 410-498-4848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN M BRUNEIO
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Credential | CRNP
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Telephone | 570-872-4533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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