Individual
DOUGLAS BAZEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3014 COOL BRANCH ROAD, CHURCHVILLE, MD 21028
(443) 617-7277
Mailing address
3014 COOL BRANCH RD, CHURCHVILLE, MD 21028-1002
(443) 617-7277
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
08/21/2017
Last updated
07/21/2022
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