MEDICARE: STATCARE GROUP 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	261QE0002X	Emergency Care Clinic/Center		MD
2	261QU0200X	Urgent Care Clinic/Center		MD

General Provider Information

NPI Number	:	1861448813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATCARE GROUP LLC

Provider Business Mailing Address
First Line	:	1400 FRONT AVENUE
Second Line	:	SUITE 109
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093
Country	:	US
Telephone Number	:	410-296-7190
Fax Number	:	443-991-7768

Provider Business Practice Location Address
First Line	:	14237 JARRETTSVILLE PIKE
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-1403
Country	:	US
Telephone Number	:	410-650-4735
Fax Number	:	410-650-4734

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. SCOTT THEODORE BURGER
Credential	:	D.O.
Telephone Number	:	410-296-7190

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/07/2020

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Directions to “STATCARE GROUP LLC ” Practice Location

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