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General NPI Number Information
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NPI Number | 1649095233
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Entity Type | Organization
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Legal Business Name | ST. AGNES HEALTHCARE, INC.
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 6740 ALEXANDER BELL DR STE 100
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City | COLUMBIA
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State | MD
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Zip | 21046-2249
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Country | US
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Telephone | 410-744-0900
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Fax | 410-477-3160
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Provider Business Mailing Address
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Address Line | 6740 ALEXANDER BELL DR STE 100
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City | COLUMBIA
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State | MD
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Zip | 21046-2249
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Country | US
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Telephone | 410-744-0900
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Fax | 410-477-3160
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. WILLIAM B HIGGINBOTHAM
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Credential |
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Telephone | 667-234-3162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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