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General NPI Number Information
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NPI Number | 1730374448
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Entity Type | Organization
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Legal Business Name | ASTHMA SINUS ALLERGY PROGRAM, LLC.
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 6535 N CHARLES STREET PPN 200
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City | TOWSON
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State | MD
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Zip | 21204
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Country | US
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Telephone | 410-583-8393
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Fax | 410-583-8394
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Provider Business Mailing Address
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Address Line | 6535 N CHARLES STREET PPN 200
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City | TOWSON
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State | MD
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Zip | 21204
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Country | US
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Telephone | 410-583-8393
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Fax | 410-583-8394
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ALVIN M SANICO
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Credential | M.D.
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Telephone | 410-583-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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