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Organization
WALLACE BRUCE OBENSHAIN CECILTON FAMILY PRACTICE
Active
Organization
WALLACE BRUCE OBENSHAIN CECILTON FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA FIELDS (CREDENTIALING COORDINATOR)
(410) 398-4679
Entity
Organization
Contact information
Practice address
251 BOHEMIA AVE, CECILTON, MD 21913
(410) 275-8157
Mailing address
PO BOX 190, ELKTON, MD 21922-0190
(410) 398-4679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0035779
MD
Other
Enumeration date
02/13/2007
Last updated
06/12/2008
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