Provider Demographics
NPI:1700211232
Name:ALDANA MEDICINE, LLC
Entity Type:Organization
Organization Name:ALDANA MEDICINE, LLC
Other - Org Name:DOCTORS EXPRESS PIKESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-4044
Mailing Address - Street 1:1860 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1335
Mailing Address - Country:US
Mailing Address - Phone:410-484-4044
Mailing Address - Fax:410-741-3797
Practice Address - Street 1:1860 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1335
Practice Address - Country:US
Practice Address - Phone:410-484-4044
Practice Address - Fax:410-741-3797
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty