Organization
MARYLAND HEALING WATERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE VIDAVER MD (PHYSICIAN)
(410) 761-7901
Entity
Organization
Contact information
Practice address
1414 CRAIN HWY N STE 6A, GLEN BURNIE, MD 21061-9307
(410) 761-7901
(410) 761-1031
Mailing address
1414 CRAIN HWY N STE 6A, GLEN BURNIE, MD 21061-9307
(410) 761-7901
(410) 761-1031
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D25559
MD
Other
Enumeration date
06/30/2011
Last updated
05/17/2024
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