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Organization
MDICS AT CIVISTA LLC
Active
Organization
MDICS AT CIVISTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM DELBRUGGE (CFO)
(301) 693-8707
Entity
Organization
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(443) 949-0814
(443) 949-0825
Mailing address
PO BOX 69231, BALTIMORE, MD 21264-9231
(443) 949-0814
(443) 292-6814
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
MD
Other
Enumeration date
06/15/2011
Last updated
08/09/2022
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