# MARYLAND HEALING WATERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366739179
- **Authorized official:** DR. LAWRENCE VIDAVER MD (PHYSICIAN)
- **Authorized official phone:** (410) 761-7901

## Contact information

- **Practice address:** 2506 LARRYVALE RD, BALTIMORE, MD 21209-3206
- **Practice address phone:** (410) 761-7901
- **Practice address fax:** (410) 761-1031
- **Mailing address:** 2506 LARRYVALE RD, BALTIMORE, MD 21209-3206
- **Mailing address phone:** (410) 761-7901
- **Mailing address fax:** (410) 761-1031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | D25559 | MD | Yes |

## Other

- **Enumeration date:** 06/30/2011
- **Last updated:** 09/15/2026