Organization
MEDICAL LEGACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUTOYIN A OKUNOREN RD (PRACTICE COORDINATOR)
(410) 655-7100
Entity
Organization
Contact information
Practice address
5310 OLD COURT RD, SUITE 305, RANDALLSTOWN, MD 21133-5243
(410) 655-7100
(410) 655-7917
Mailing address
5310 OLD COURT RD, SUITE 305, RANDALLSTOWN, MA 21133
(410) 655-7100
(410) 655-7917
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D0023724
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255951000
—
MD
Enumeration date
06/27/2008
Last updated
06/27/2008
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