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General NPI Number Information
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NPI Number | 1336159284
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Entity Type | Organization
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Legal Business Name | HOWARD COUNTY GASTROINTESTINAL DIAGNOSTIC CTR, LLC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 10710 CHARTER DR SUITE 120
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City | COLUMBIA
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State | MD
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Zip | 21044-2858
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Country | US
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Telephone | 410-772-7345
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Fax | 410-772-8860
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Provider Business Mailing Address
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Address Line | 10710 CHARTER DR SUITE 120
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City | COLUMBIA
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State | MD
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Zip | 21044-2858
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Country | US
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Telephone | 410-772-7345
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Fax | 410-772-8860
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | A1342
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License Number State | MD
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