ETHOS HEALTH MARYLAND 4 LLC NPI 1912542192

NPI Information

NPI: 1912542192
Provider Name: ETHOS HEALTH MARYLAND 4, LLC
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

Address:
1411 MADISON PARK DR
GLEN BURNIE, MD
ZIP 21061
Phone: (352) 732-5590
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ETHOS HEALTH MARYLAND 4, LLC is a health service clinic center in Glen Burnie, MD. ETHOS HEALTH MARYLAND 4, LLC NPI is 1912542192. The provider is registered as an organization entity type.

The provider's business location address is:

1411 MADISON PARK DR
GLEN BURNIE, MD
ZIP 21061-185
Phone: (352) 732-5590
Fax: (352) 732-0292

The provider's authorized official is Jonathan Ray Walker .
The authorized official title is Owner and has the following contact phone number (352) 732-5590.

The enumeration date for this NPI number is 11/12/2019 and was last updated on 10/13/2021.

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
1	261QH0100X	Clinic/Center	Health Service			Yes

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

NPI Synchronization or Removal

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