Provider Demographics
NPI:1063843589
Name:AIRPARK PRIMARY CARE
Entity Type:Organization
Organization Name:AIRPARK PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RUZBARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-848-8882
Mailing Address - Street 1:125 AIRPORT DR UNIT 34
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3038
Mailing Address - Country:US
Mailing Address - Phone:410-848-8882
Mailing Address - Fax:
Practice Address - Street 1:125 AIRPORT DR UNIT 34
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3038
Practice Address - Country:US
Practice Address - Phone:410-848-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000786261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007M0791Medicare UPIN