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General NPI Number Information
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NPI Number | 1942025630
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Entity Type | Organization
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Legal Business Name | ST. AGNES HEALTHCARE, INC.
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 6740 ALEXANDER BELL DR STE 200
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City | COLUMBIA
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State | MD
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Zip | 21046-2250
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Country | US
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Telephone | 667-234-6885
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Fax | 443-708-9346
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Provider Business Mailing Address
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Address Line | 6740 ALEXANDER BELL DR STE 200
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City | COLUMBIA
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State | MD
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Zip | 21046-2250
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Country | US
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Telephone | 667-234-6885
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Fax | 443-708-9346
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | WILLIAM B HIGGINBOTHAM
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Credential |
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Telephone | 667-234-3162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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