Individual
BROOKELLEN RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
314 FRANKLIN AVE, SUITE 403, BERLIN, MD 21811
(410) 629-1995
(410) 629-1993
Mailing address
PO BOX 49, 400 EASTERN SHORE DRIVE, SALISBURY, MD 21804
(410) 749-0821
(410) 219-5662
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H0044828
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
483791600
—
MD
Enumeration date
10/11/2005
Last updated
08/17/2018
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