Provider Demographics
NPI:1780039818
Name:DRS ERGENT CARE, LLC
Entity Type:Organization
Organization Name:DRS ERGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFENBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-507-9698
Mailing Address - Street 1:5005 SIGNAL BELL LN STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2608
Mailing Address - Country:US
Mailing Address - Phone:410-721-2333
Mailing Address - Fax:
Practice Address - Street 1:1071 ROUTE 3 N
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-507-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060177261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67080Medicare UPIN