MEDICARE: CAPRICORN HEALTH 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	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1326639204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPRICORN HEALTH LLC

Provider Business Mailing Address
First Line	:	101 CHESAPEAKE BLVD STE B
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-6607
Country	:	US
Telephone Number	:	443-553-0057
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 WALNUT LN
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2479
Country	:	US
Telephone Number	:	443-345-4146
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CHRISTOPHER GELMANN
Credential	:	MD
Telephone Number	:	443-553-0057

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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