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General NPI Number Information
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NPI Number | 1518339209
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Entity Type | Organization
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Legal Business Name | CORELIFE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 579 BALTIMORE ANNAPOLIS BLVD
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City | SEVERNA PARK
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State | MD
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Zip | 21146-3809
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Country | US
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Telephone | 410-975-5447
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Fax | 888-709-8865
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Provider Business Mailing Address
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Address Line | 1111 BENFIELD BLVD STE 250
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City | MILLERSVILLE
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State | MD
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Zip | 21108-3005
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Country | US
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Telephone | 443-679-4309
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Fax | 855-772-4748
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. STEPHAN R IZZI
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Credential | MD
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Telephone | 410-975-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0025782
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License Number State | MD
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