Provider Demographics
NPI:1598199093
Name:MEDSTAR URGENT CARE
Entity Type:Organization
Organization Name:MEDSTAR URGENT CARE
Other - Org Name:MEDSTAR PROMPTCARE PERRY HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHKA-CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-772-6827
Mailing Address - Street 1:8605 RIDGELY'S CHOICE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-248-2310
Mailing Address - Fax:410-248-2311
Practice Address - Street 1:8605 RIDGELY'S CHOICE DRIVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-248-2310
Practice Address - Fax:410-248-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03695726261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD240253Medicare PIN