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General NPI Number Information
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NPI Number | 1275993495
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Entity Type | Organization
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Legal Business Name | MAINLINE URGENT CARE MEDICAL GROUP P.C
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 3193 CAPE HORN RD
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City | RED LION
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State | PA
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Zip | 17356-8810
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Country | US
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Telephone | 610-482-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 E CHURCHVILLE RD
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City | BEL AIR
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State | MD
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Zip | 21014-4742
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Country | US
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Telephone | 410-420-6970
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Fax |
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Authorized Official
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Title or Position | CEO/MD
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Name | DR. MAURICE NATHANIEL REID
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Credential | M.D.
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Telephone | 410-420-6970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MD442240
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License Number State | PA
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