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General NPI Number Information
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NPI Number | 1396509246
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Entity Type | Organization
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Legal Business Name | RESTORATIVE MEDICINE AND AESTHETICS IN ANNAPOLIS
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1321 GENERALS HWY STE 303
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City | CROWNSVILLE
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State | MD
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Zip | 21032-2060
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Country | US
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Telephone | 410-858-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 GENERALS HWY STE 303
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City | CROWNSVILLE
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State | MD
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Zip | 21032-2060
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Country | US
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Telephone | 410-858-1112
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CARMEN HILLER
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Credential | MD
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Telephone | 410-858-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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