Provider Demographics
NPI:1578891214
Name:CAL ARUNDEL FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:CAL ARUNDEL FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-414-9879
Mailing Address - Street 1:32 COX RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-9278
Mailing Address - Country:US
Mailing Address - Phone:410-414-9879
Mailing Address - Fax:410-535-7684
Practice Address - Street 1:32 COX RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-9278
Practice Address - Country:US
Practice Address - Phone:410-414-9879
Practice Address - Fax:410-535-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1205845799OtherINDIVIDUAL NPI
MD407730000Medicaid