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BLACKWATER MEDICAL ASSOCIATES LLC NPI 1063722171


NPI Information

NPI: 1063722171
Provider Name: BLACKWATER MEDICAL ASSOCIATES, LLC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
408 BYRN ST
CAMBRIDGE, MD
ZIP 21613
Phone: (410) 228-1068
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BLACKWATER MEDICAL ASSOCIATES, LLC is a specialist in Cambridge, MD. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. BLACKWATER MEDICAL ASSOCIATES, LLC NPI is 1063722171. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

408 BYRN ST
CAMBRIDGE, MD
ZIP 21613-910
Phone: (410) 228-1068
Fax: (410) 228-6338

The provider's authorized official is Mark Malkus .
The authorized official title is President and has the following contact phone number (410) 228-1068.

The enumeration date for this NPI number is 10/8/2010 and was last updated on 10/8/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistD0080504MARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G28888MEDICARE UPINMARYLAND
2781000800MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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