Organization · NPI-2

126th Street Medical

Family Medicine · Ocean City, MD

NPI number1316949787
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1316949787
Entity type
Organization (NPI-2)
Legal business name
126th Street Medical
Organization subpart
No
Enumeration date
Aug 15, 2005
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineD0032615MDYes

Practice location

12601 D Coastal Highway
Ocean City, MD 21842-9784

Phone 410-250-8000 · Fax 410-250-1308

Mailing address

12601 D Coastal Highway
Ocean City, MD 21842-9784

Phone 410-250-8000 · Fax 410-250-1308

Authorized official

Victor Gong
Medical Officer
4102508000

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Family Medicine providers in Ocean City, MD