Provider Demographics
NPI:1528933934
Name:WATERFRONT MEDICAL, LLC
Entity type:Organization
Organization Name:WATERFRONT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-788-3557
Mailing Address - Street 1:7 POST OFFICE RD STE M
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2744
Mailing Address - Country:US
Mailing Address - Phone:240-270-1069
Mailing Address - Fax:301-560-8244
Practice Address - Street 1:7 POST OFFICE RD STE M
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2744
Practice Address - Country:US
Practice Address - Phone:240-270-1069
Practice Address - Fax:301-560-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty