Provider Demographics
NPI:1487824009
Name:OB-GYN SPECIALISTS OF MARYLAND, LLC
Entity Type:Organization
Organization Name:OB-GYN SPECIALISTS OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN BLARGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-832-5511
Mailing Address - Street 1:100 WEST RD STE 404
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2368
Mailing Address - Country:US
Mailing Address - Phone:410-832-5511
Mailing Address - Fax:410-832-5560
Practice Address - Street 1:100 WEST RD STE 404
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2368
Practice Address - Country:US
Practice Address - Phone:410-832-5511
Practice Address - Fax:410-832-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
211MMedicare PIN