PREMISE HEALTH OF MARYLAND MEDICAL P C NPI 1073258661

NPI Information

PREMISE HEALTH OF MARYLAND MEDICAL P C is a multi-specialty clinic center in Frederick, MD. PREMISE HEALTH OF MARYLAND MEDICAL P C NPI is 1073258661. The provider is registered as an organization entity type.

The provider's business location address is:

9021 BENNETT CREEK BLVD
FREDERICK, MD
ZIP 21704-639
Phone: (240) 346-3549

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 21D2268569 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/28/2022 and was last updated on 4/28/2022.

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:

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