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General NPI Number Information
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NPI Number | 1578891214
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Entity Type | Organization
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Legal Business Name | CAL ARUNDEL FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 32 COX RD
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-9278
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Country | US
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Telephone | 410-414-9879
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Fax | 410-535-7684
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Provider Business Mailing Address
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Address Line | 32 COX RD
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-9278
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Country | US
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Telephone | 410-414-9879
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Fax | 410-535-7684
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY JOHN WISNIEWSKI
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Credential | M.D.
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Telephone | 410-414-9879
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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 | 207Q00000X
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License Number State | MD
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