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Organization

SETON MEDICAL GROUP, INC

Active
Parent organization
ASCENSION HEALTH
Other names
Ascension Saint Agnes Primary Care Ellicott City
Organization subpart
Yes

Provider details

NPI number
Legal business name
ASCENSION HEALTH
Authorized official
MR. WILLIAM B HIGGINBOTHAM (PRESIDENT/CEO)
(667) 234-3162
Entity
Organization

Contact information

Practice address
2850 NORTH RIDGE ROAD, SUITE 103, ELLICOTT CITY, MD 21043-3396
(410) 465-8119
Mailing address
2850 NORTH RIDGE ROAD, SUITE 103, ELLICOTT CITY, MD 21043-3396
(410) 465-8119

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician

Other

Enumeration date
10/17/2024
Last updated
10/31/2024
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