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General NPI Number Information
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NPI Number | 1740574763
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Entity Type | Organization
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Legal Business Name | BRIGHTSEAT SPECIALIST CARE
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 1827 BRIGHTSEAT RD
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City | LANDOVER
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State | MD
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Zip | 20785-4250
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Country | US
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Telephone | 301-386-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 1827 BRIGHTSEAT RD
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City | LANDOVER
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State | MD
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Zip | 20785-4250
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Country | US
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Telephone | 301-386-6090
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERRIE L BALLENGER
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Credential |
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Telephone | 301-386-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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