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General NPI Number Information
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NPI Number | 1699594044
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Entity Type | Organization
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Legal Business Name | MILES RIVER PRIMARY CARE LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 618 SUNBURST HWY
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2546
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Country | US
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Telephone | 667-372-0228
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Fax | 410-822-9513
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Provider Business Mailing Address
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Address Line | 618 SUNBURST HWY
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. TAMMY SMITH
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Credential |
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Telephone | 410-822-9133
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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 |
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