Organization
SOUTH MOUNTAIN COMMUNITY HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY GALLOWAY ELIZALDE CRNP (OWNER)
(301) 432-6897
Entity
Organization
Contact information
Practice address
9 SAINT PAUL ST STE 3, BOONSBORO, MD 21713
(301) 432-6897
(301) 432-6298
Mailing address
9 SAINT PAUL ST, 2ND FLOOR, BOONSBORO, MD 21713-1334
(301) 432-6897
(301) 432-6298
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R100650
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
544300800
—
MD
Enumeration date
10/31/2007
Last updated
07/23/2018
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