Provider Demographics
NPI:1942578919
Name:MARYLAND MEDICAL REHABILITATION, P.C.
Entity Type:Organization
Organization Name:MARYLAND MEDICAL REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORISCINE
Authorized Official - Middle Name:LENAY
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-685-1188
Mailing Address - Street 1:PO BOX 6553
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6553
Mailing Address - Country:US
Mailing Address - Phone:410-685-1188
Mailing Address - Fax:410-685-1889
Practice Address - Street 1:2530 N CHARLES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4640
Practice Address - Country:US
Practice Address - Phone:410-685-1188
Practice Address - Fax:410-685-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046464208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty