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General NPI Number Information
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NPI Number | 1881443554
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Entity Type | Organization
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Legal Business Name | MARYLAND NEUROMUSCULAR CENTER LLC
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Dates
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Enumeration Date | 05/15/2024
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 11055 LITTLE PATUXENT PKWY STE 203
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City | COLUMBIA
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State | MD
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Zip | 21044-2898
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Country | US
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Telephone | 443-524-0885
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Fax | 443-524-0887
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Provider Business Mailing Address
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Address Line | 11055 LITTLE PATUXENT PKWY STE 203
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City | COLUMBIA
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State | MD
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Zip | 21044-2898
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Country | US
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Telephone | 443-524-0885
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Fax | 443-524-0887
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DERRICK ALWYN FOX
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Credential | MD
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Telephone | 443-524-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) 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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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