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General NPI Number Information
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NPI Number | 1770190647
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Entity Type | Organization
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Legal Business Name | MEDICAL MARYLAND STAR CHOICE LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 5999 HARPERS FARM RD STE W230
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City | COLUMBIA
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State | MD
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Zip | 21044-3025
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Country | US
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Telephone | 410-383-2250
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Fax | 410-383-8378
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Provider Business Mailing Address
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Address Line | 5999 HARPERS FARM RD STE W230
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City | COLUMBIA
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State | MD
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Zip | 21044-3025
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Country | US
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Telephone | 410-383-2250
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Fax | 410-383-8378
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Authorized Official
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Title or Position | CEO
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Name | KINAN KNAISH
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Credential | MD
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Telephone | 410-383-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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