MEDICARE: SANGJIN OH MD PA

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1730745159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANGJIN OH MD PA

Provider Business Mailing Address
First Line	:	1412 CRAIN HWY N STE 6A
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-7000
Country	:	US
Telephone Number	:	410-761-3900
Fax Number	:	410-761-4500

Provider Business Practice Location Address
First Line	:	1412 CRAIN HWY N STE 6A
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-7000
Country	:	US
Telephone Number	:	410-761-3900
Fax Number	:	410-761-4500

Authorized Official
Title or Position	:	NURSE
Name	:	HILLARY WILSON
Credential	:
Telephone Number	:	410-761-3900

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/31/2019

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