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General NPI Number Information
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NPI Number | 1447585120
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Entity Type | Organization
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Legal Business Name | CAG GROUP PC
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 1319 PARK AVE
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City | BALTIMORE
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State | MD
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Zip | 21217-4104
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Country | US
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Telephone | 443-927-7364
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Fax | 800-419-7485
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Provider Business Mailing Address
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Address Line | 7095 HOLLYWOOD BLVD SUITE 338
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City | HOLLYWOOD
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State | CA
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Zip | 90028-8903
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Country | US
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Telephone | 443-927-7364
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Fax | 800-419-7485
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAURICE M VINCENT
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Credential | MD
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Telephone | 443-927-7364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 21D0649684
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License Number State | MD
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