Provider Demographics
NPI:1568421659
Name:OSLER DRIVE EMERGENCY PHYSCIANS ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:OSLER DRIVE EMERGENCY PHYSCIANS ASSOCIATES, P.A.
Other - Org Name:ODEPA PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUVOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-695-5507
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21018-0130
Mailing Address - Country:US
Mailing Address - Phone:877-346-2211
Mailing Address - Fax:
Practice Address - Street 1:7601 OSLER DR
Practice Address - Street 2:SAINT JOSEPH MEDICAL CENTER
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7700
Practice Address - Country:US
Practice Address - Phone:877-346-2211
Practice Address - Fax:410-337-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207P00000X207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD910081400Medicaid
MD910081400Medicaid