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General NPI Number Information
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NPI Number | 1942875026
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Entity Type | Organization
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Legal Business Name | OWENSVILLE PRIMARY CARE,INC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 5408 SOUTHERN MARYLAND BLVD UNIT 7
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City | LOTHIAN
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State | MD
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Zip | 20711-2602
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Country | US
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Telephone | 410-867-4700
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Fax | 410-867-4934
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Provider Business Mailing Address
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Address Line | 134 OWENSVILLE RD
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City | WEST RIVER
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State | MD
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Zip | 20778-9702
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Country | US
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Telephone | 410-867-4700
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Fax | 410-867-4934
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | CHRISTINA VARGA
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Credential |
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Telephone | 410-867-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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