Organization
ST. MARY'S MULTISPECIALITY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L ASHBURN (CLIENT MANAGER)
(410) 828-8110
Entity
Organization
Contact information
Practice address
8725 LOCH RAVEN BLVD, SUITE 200, TOWSON, MD 21286-2227
(410) 828-8100
(410) 882-3310
Mailing address
25500 POINT LOOKOUT ROAD, LEONARDTOWN, MD 20650
(410) 828-8100
(410) 882-3310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F571
BLUE CHOICE
MD
01
—
KJ34ST
CAREFIRST
MD
Enumeration date
08/24/2006
Last updated
08/22/2020
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