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General NPI Number Information
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NPI Number | 1932376100
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Entity Type | Organization
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Legal Business Name | MARYLAND HOLISTIC HEALTHCARE, P.C.
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 5115 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21207-7056
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Country | US
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Telephone | 301-560-1750
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Fax | 301-560-6322
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Provider Business Mailing Address
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Address Line | 10307 W BROAD ST SUITE 304
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6716
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Country | US
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Telephone | 301-560-1750
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Fax | 301-560-6322
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAMELA JOCELYN ADRIENNE HEATH
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Credential | D.O.
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Telephone | 301-300-8461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0061034
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License Number State | MD
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