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General NPI Number Information
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NPI Number | 1538894340
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL CENTER LEADING THE WAY IN HEALTHCARE
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 3169 BRAVERTON ST STE 102
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City | EDGEWATER
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State | MD
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Zip | 21037-2666
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Country | US
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Telephone | 240-694-8504
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Fax |
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Provider Business Mailing Address
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Address Line | 12908 GOLDEN OAK DR
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City | LAUREL
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State | MD
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Zip | 20708-2330
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Country | US
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Telephone | 240-694-8504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE DUNCAN
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Credential | CRNP
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Telephone | 240-694-8504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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