Organization
ELLICOTT CITY PRIMARY CARE MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EDWARD SHEEHAN III M.D. (PRESIDENT)
(410) 465-1090
Entity
Organization
Contact information
Practice address
10298B BALTIMORE NATIONAL PIKE, ELLICOTT CITY, MD 21042-3670
(410) 465-1091
(410) 465-8129
Mailing address
10298B BALTIMORE NATIONAL PIKE, ELLICOTT CITY, MD 21042-3670
(410) 465-1091
(410) 465-8129
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0028246
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ORGANIZATIONAL NPI
1033391081
—
Enumeration date
12/02/2007
Last updated
09/17/2012
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