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General NPI Number Information
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NPI Number | 1336136035
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Entity Type | Organization
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Legal Business Name | CATONSVILLE PRIMARY CARE CENTER, PA
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 405 FREDERICK RD SUITE 210
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City | CATONSVILLE
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State | MD
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Zip | 21228-4645
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Country | US
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Telephone | 410-788-6565
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Fax | 410-747-4688
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Provider Business Mailing Address
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Address Line | 405 FREDERICK RD SUITE 210
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City | CATONSVILLE
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State | MD
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Zip | 21228-4645
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Country | US
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Telephone | 410-788-6565
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Fax | 410-747-4688
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. NANCY L SULLIVAN
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Credential |
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Telephone | 410-788-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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