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General NPI Number Information
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NPI Number | 1518890870
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Entity Type | Organization
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Legal Business Name | PROVIDER PARTNERS SENIOR CARE LP
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 8820 COLUMBIA 100 PKWY STE 430
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City | COLUMBIA
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State | MD
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Zip | 21045-2175
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Country | US
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Telephone | 410-967-2097
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Fax |
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Provider Business Mailing Address
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Address Line | 8820 COLUMBIA 100 PKWY STE 430
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City | COLUMBIA
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State | MD
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Zip | 21045-2175
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Country | US
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Telephone | 410-967-2097
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | KEITH DOUGLAS PERSINGER
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Credential |
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Telephone | 410-456-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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