Provider Demographics
NPI:1275552457
Name:C AND S MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:C AND S MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CWIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-536-4818
Mailing Address - Street 1:PO BOX 7362
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-0362
Mailing Address - Country:US
Mailing Address - Phone:410-536-4818
Mailing Address - Fax:410-247-2346
Practice Address - Street 1:4713 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1402
Practice Address - Country:US
Practice Address - Phone:410-536-4818
Practice Address - Fax:410-247-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD164NMedicare ID - Type Unspecified