Provider Demographics
NPI:1003552118
Name:OWENS OF CROFTON LLC
Entity Type:Organization
Organization Name:OWENS OF CROFTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-261-3800
Mailing Address - Street 1:1664 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2037
Mailing Address - Country:US
Mailing Address - Phone:301-261-3800
Mailing Address - Fax:
Practice Address - Street 1:1664 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2037
Practice Address - Country:US
Practice Address - Phone:301-261-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental