Organization
EASTERN SHORE LITHOTRIPSY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN P KNUD-HANSEN MD (OWNER)
(410) 822-5552
Entity
Organization
Contact information
Practice address
6 CAULK LN, EASTON, MD 21601-3854
(410) 822-5552
(410) 822-8238
Mailing address
6 CAULK LN, EASTON, MD 21601-3854
(410) 822-5552
(410) 822-8238
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary
A1180
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57410502
BCBS OF MD PROVIDER NUMBE
MD
01
—
RV9
BCBS OF DC PROVIDER NUMBE
MD
Enumeration date
10/20/2006
Last updated
08/22/2020
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