Organization
INTEGRACE HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYSON R. LUCKENBAUGH (CHIEF FINANCIAL OFFICER)
(410) 970-2071
Entity
Organization
Contact information
Practice address
7200 3RD AVE, SYKESVILLE, MD 21784-5201
(410) 795-8808
Mailing address
PO BOX 1000, 7200 THIRD AVE, SYKESVILLE, MD 21784-1000
(410) 795-8808
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040246
MD DHMH OFFICE OF HTH CA
—
05
—
126651900
—
MD
Enumeration date
07/27/2006
Last updated
04/01/2016
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