Provider Demographics
NPI:1619245289
Name:MONOCACY HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:MONOCACY HEALTH PARTNERS LLC
Other - Org Name:UNION BRIDGE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-566-3355
Mailing Address - Street 1:PO BOX 1110
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-1110
Mailing Address - Country:US
Mailing Address - Phone:410-775-2622
Mailing Address - Fax:410-775-2050
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION BRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21791-9102
Practice Address - Country:US
Practice Address - Phone:410-775-2622
Practice Address - Fax:410-775-2050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONOCACY HEALTH PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-09
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty