Provider Demographics
NPI:1013972975
Name:TOWSON MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TOWSON MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-769-4920
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-769-4920
Mailing Address - Fax:410-296-4205
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-769-4920
Practice Address - Fax:410-296-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
895LMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER