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General NPI Number Information
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NPI Number | 1952970816
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 6310 STEVENS FOREST RD STE 200
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City | COLUMBIA
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State | MD
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Zip | 21046-1068
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Country | US
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Telephone | 410-740-9001
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Fax | 410-740-9005
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Provider Business Mailing Address
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Address Line | 14520 EDGEWOODS WAY
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City | GLENELG
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State | MD
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Zip | 21737-9608
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Country | US
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Telephone | 410-245-2414
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Fax | 410-740-9005
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Authorized Official
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Title or Position | OWNER
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Name | NJIDEKA UDOCHI
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Credential | MD
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Telephone | 410-245-2414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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