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General NPI Number Information
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NPI Number | 1942155122
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Entity Type | Organization
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Legal Business Name | MARYLAND PHYSICIANS EDGE LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 308 N UNION AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2825
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Country | US
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Telephone | 410-939-3121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14079
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City | BELFAST
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State | ME
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Zip | 04915-4031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TRACEY M MORAN
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Credential |
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Telephone | 301-681-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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