Organization
ACHD-INFANT & TODDLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENELLE MAYER DO (HEALTH OFFICER)
(301) 759-5001
Entity
Organization
Contact information
Practice address
12501 WILLOWBROOK RD, CUMBERLAND, MD 21502-2554
(301) 759-5080
(301) 777-2063
Mailing address
PO BOX 1745, CUMBERLAND, MD 21501-1745
(301) 759-5000
(301) 777-5674
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003431201
—
MD
Enumeration date
03/19/2007
Last updated
03/11/2022
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