Organization
75TH STREET INJURY & ILLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA W RANDOLPH PA-C (ADMINISTRATOR)
(410) 524-0075
Entity
Organization
Contact information
Practice address
7408 COASTAL HWY, OCEAN CITY, MD 21842-2936
(410) 524-0075
Mailing address
12547 OCEAN GTWY, OCEAN CITY, MD 21842-9689
(410) 213-0119
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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