Organization
CHILDREN'S MEDICAL GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERIE LOUISE WILSON (OFFICE MANAGER)
(301) 724-7616
Entity
Organization
Contact information
Practice address
500 GREENE ST, CUMBERLAND, MD 21502-2755
(301) 724-7616
(301) 724-4811
Mailing address
500 GREENE ST, CUMBERLAND, MD 21502-2755
(301) 724-7616
(301) 724-4811
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008109000
—
WV
05
—
910551400
—
MD
Enumeration date
09/20/2006
Last updated
09/30/2011
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