Organization
CIVISTA CLINICAL SERCIVES, LLC
Active
Parent organization
UNIVERSITY OF MARYLAND CHARLES REGIONAL MEDICAL GROUP
Other names
University of Maryland Charles Regional Neurology Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF MARYLAND CHARLES REGIONAL MEDICAL GROUP
Authorized official
STEPHANIE SIMM (PHYSICIAN RELATIONS SPECIALIST)
(301) 609-4539
Entity
Organization
Contact information
Practice address
101 CENTENNIAL ST, SUITE B, LA PLATA, MD 20646-5975
(301) 609-4539
Mailing address
75 REMITTANCE DR DEPT 6554, CHICAGO, IL 60675-6554
(301) 609-4539
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Enumeration date
05/29/2012
Last updated
06/12/2014
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