MEDICARE: FAMILY MEDICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R069707	MD

General Provider Information

NPI Number	:	1225226046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	332 140 VILLAGE RD
Second Line	:	#167
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6196
Country	:	US
Telephone Number	:	410-876-9785
Fax Number	:	410-871-1988

Provider Business Practice Location Address
First Line	:	708C LISBON CENTER DR
Second Line	:
City	:	WOODBINE
State	:	MD
Zip	:	21797-8600
Country	:	US
Telephone Number	:	410-795-7221
Fax Number	:	410-795-8920

Authorized Official
Title or Position	:	OPERATIONAL MANAGER
Name	:	BEVERLY ELLIOTT
Credential	:
Telephone Number	:	410-876-9785

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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