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General NPI Number Information
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NPI Number | 1346608171
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Entity Type | Organization
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Legal Business Name | JUNIPER HEALTHCARE LLC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 1502 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-5019
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Country | US
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Telephone | 410-747-3287
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Fax | 410-465-3716
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Provider Business Mailing Address
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Address Line | 9055 CHEVROLET DR STE 103
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-4091
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Country | US
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Telephone | 443-804-4268
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Fax | 410-465-3716
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MITUL DAVE
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Credential | MD
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Telephone | 443-804-4628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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