Organization
SOUTH MOUNTAIN FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM F BODENHEIMER III MD (OWNER)
(301) 432-0623
Entity
Organization
Contact information
Practice address
9 SAINT PAUL ST, BOONSBORO, MD 21713-1334
(301) 432-0623
(301) 432-0624
Mailing address
9 SAINT PAUL ST, BOONSBORO, MD 21713-1334
(301) 432-0623
(301) 432-0624
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
D0056826
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
864001700
—
MD
Enumeration date
07/26/2007
Last updated
06/29/2011
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