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Organization
LITTLE DOC RIDER PC
Active
Organization
LITTLE DOC RIDER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKELLEN RIDER DO (PROPRIETOR)
(410) 629-1995
Entity
Organization
Contact information
Practice address
314 FRANKLIN AVE, SUITE 403, BERLIN, MD 21811-1215
(410) 629-1995
(410) 629-1993
Mailing address
PO BOX 1578, BERLIN, MD 21811-5578
(410) 641-9450
(410) 641-9515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/11/2006
Last updated
12/10/2009
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