Provider Demographics
NPI:1881662302
Name:PATAPSCO EYE MDS, LLC
Entity Type:Organization
Organization Name:PATAPSCO EYE MDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-283-8800
Mailing Address - Street 1:6350 STEVENS FOREST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3231
Mailing Address - Country:US
Mailing Address - Phone:443-283-8800
Mailing Address - Fax:443-283-8801
Practice Address - Street 1:6350 STEVENS FOREST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3231
Practice Address - Country:US
Practice Address - Phone:443-283-8800
Practice Address - Fax:443-283-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD938M742FMedicare ID - Type Unspecified