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Organization

UMMC MIDTOWN CAMPUS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. WAYNE LOUIS CVACH RRT,CPFT (DIRECTOR)
(410) 225-8016
Entity
Organization

Contact information

Practice address
827 LINDEN AVE, BALTIMORE, MD 21201-4606
(410) 225-8010
(410) 462-6093
Mailing address
827 LINDEN AVE, BALTIMORE, MD 21201-4606
(410) 225-8010
(410) 462-6093

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
1057
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1669565180
MD
Enumeration date
09/18/2014
Last updated
09/18/2014
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