Organization
GUNPOWDER RIVER PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M. FIRTH (BILLING)
(410) 679-0012
Entity
Organization
Contact information
Practice address
626 TOWNE CENTER DR, SUITE 202, JOPPA, MD 21085-4446
(410) 679-0012
Mailing address
626 TOWNE CENTER DR, SUITE 202, JOPPA, MD 21085-4446
(410) 679-0012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D39836
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CBN2PA
CAREFIRST
MD
01
—
U642 0001
CAREFIRST
DC
Enumeration date
05/08/2009
Last updated
04/02/2012
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