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General NPI Number Information
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NPI Number | 1770764490
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Entity Type | Organization
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Legal Business Name | BLUE WATER PHYSIATRY L L C
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 7501 SURRATTS ROAD #202
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City | CLINTON
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State | MD
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Zip | 20735-2256
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Country | US
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Telephone | 301-877-6110
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Fax | 301-877-2695
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Provider Business Mailing Address
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Address Line | 6368 COVENTRY WAY #365
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City | CLINTON
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State | MD
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Zip | 20735-2256
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Country | US
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Telephone | 301-877-6110
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Fax | 301-877-2695
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARTHUR PETER BARLETTA
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Credential | MD
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Telephone | 301-877-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | D0039416
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D0039416
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License Number State | MD
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