Organization
WALLACE BRUCE OBENSHAIN CECILTON FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA FIELDS (CREDENTIALING COORDINATOR)
(410) 398-4679
Entity
Organization
Contact information
Practice address
251 BOHEMIA AVE, CECILTON, MD 21913
(410) 275-8157
Mailing address
PO BOX 190, ELKTON, MD 21922-0190
(410) 398-4679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0035779
MD
Other
Enumeration date
02/13/2007
Last updated
06/12/2008
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