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General NPI Number Information
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NPI Number | 1528444890
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Entity Type | Organization
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Legal Business Name | MEDSTAR ACCOUNTABLE CARE, LLC
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 5565 STERRETT PLACE 5TH FLOOR
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 410-722-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 STERRETT PLACE 5TH FLOOR
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 410-722-6500
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. ERIC R WAGNER
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Credential |
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Telephone | 410-772-6595
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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 |
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MD
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