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General NPI Number Information
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NPI Number | 1699774018
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Entity Type | Organization
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Legal Business Name | LIFESTAR RESPONSE OF MARYLAND, INC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 10840 GUILFORD RD STE 404
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City | ANNAPOLIS JUNCTION
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State | MD
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Zip | 20701-1110
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Country | US
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Telephone | 410-247-1178
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Fax | 410-536-5476
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Provider Business Mailing Address
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Address Line | PO BOX 827284
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City | PHILADELPHIA
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State | PA
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Zip | 19182-7284
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Country | US
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Telephone | 410-247-1178
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Fax | 410-536-5476
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Authorized Official
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Title or Position | REGIONAL CEO
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Name | ADAM KOONTZ
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Credential |
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Telephone | 929-464-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 74
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License Number State | MD
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