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NPI Code Detail

MEDICARE: STATCARE GROUP III, PC

MEDICARE: STATCARE GROUP III, PC
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
1261QE0002XEmergency Care Clinic/CenterMD
2261QU0200XUrgent Care Clinic/CenterMD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H0062737OTHERMDLICENSE NUMBER

General Provider Information

NPI Number : 1902261308
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATCARE GROUP III, PC
Provider Business Mailing Address
First Line : 1400 FRONT AVENUE
Second Line : SUITE 300
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 : 8 DENTON PLAZA
Second Line :
City : DENTON
State : MD
Zip : 21629-9501
Country : US
Telephone Number : 443-606-2300
Fax Number : 443-606-2305
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : DR. SCOTT T BURGER
Credential : D.O.
Telephone Number : 410-296-7190
Provider Enumeration Date : 12/30/2015
Last Update Date : 07/07/2020

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