Provider Demographics
NPI:1194018085
Name:HEALTHY LIFE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:HEALTHY LIFE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-902-4770
Mailing Address - Street 1:9607 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4129
Mailing Address - Country:US
Mailing Address - Phone:410-902-4770
Mailing Address - Fax:410-902-4779
Practice Address - Street 1:9607 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4129
Practice Address - Country:US
Practice Address - Phone:410-902-4770
Practice Address - Fax:410-902-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain