MEDICARE: HEALOGICS SPECIALTY PHYSICIANS OF MARYLAND, 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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1811855240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGICS SPECIALTY PHYSICIANS OF MARYLAND, LLC

Provider Business Mailing Address
First Line	:	5220 BELFORT RD STE 130
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11890 HEALING WAY STE 1210
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7917
Country	:	US
Telephone Number	:	240-637-5908
Fax Number	:	301-388-7525

Authorized Official
Title or Position	:	CEO
Name	:	PAM MANDEL
Credential	:
Telephone Number	:	904-446-3701

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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