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General NPI Number Information
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NPI Number | 1720307879
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Entity Type | Organization
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Legal Business Name | MARYLAND ADVANCED ARTHRITIS AND RHEUMATOLOGY CENTER
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 3147 GALAXY WAY
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City | LAUREL
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State | MD
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Zip | 20724-6113
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Country | US
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Telephone | 240-417-1206
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Fax |
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Provider Business Mailing Address
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Address Line | 3147 GALAXY WAY
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City | LAUREL
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State | MD
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Zip | 20724-6113
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Country | US
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Telephone | 240-417-1206
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. STEPHANY ANN-MARIE MCGANN
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Credential | M.D.
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Telephone | 240-417-1206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | D68062
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License Number State | MD
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