=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740455039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2008
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10724 LITTLE PATUXENT PKWY STE 101
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-3253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-740-1000
-----------------------------------------------------
Fax | 410-740-1003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10724 LITTLE PATUXENT PKWY STE 101
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-3253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-740-1000
-----------------------------------------------------
Fax | 410-740-1003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. NATHANIEL CARTER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-740-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | D46633
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------