Provider Demographics
NPI:1508178005
Name:MARYLAND HEALTHY WEIGHS, LLC
Entity Type:Organization
Organization Name:MARYLAND HEALTHY WEIGHS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-205-4421
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-5109
Mailing Address - Country:US
Mailing Address - Phone:443-205-4421
Mailing Address - Fax:
Practice Address - Street 1:124 MARKET SQ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1860
Practice Address - Country:US
Practice Address - Phone:443-205-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty