Provider Demographics
NPI:1306180013
Name:MARYLAND MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:MARYLAND MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:YERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-662-0757
Mailing Address - Street 1:1090 W PATRICK ST
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3967
Mailing Address - Country:US
Mailing Address - Phone:301-663-0757
Mailing Address - Fax:301-662-0725
Practice Address - Street 1:1090 W PATRICK ST
Practice Address - Street 2:UNIT 2A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3967
Practice Address - Country:US
Practice Address - Phone:301-663-0757
Practice Address - Fax:301-662-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41717261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care