Civista Clinical Sercives, LLC
Psychiatry & Neurology, Neurology in La Plata, MD. Organization (NPI-2).
NPI number1619237344
StatusActive
Last updated in NPPESJun 12, 2014
Details
- NPI
- 1619237344
- Entity type
- Organization (NPI-2)
- Legal business name
- Civista Clinical Sercives, LLC
- Organization subpart
- Yes
- Enumeration date
- May 29, 2012
- Last updated
- Jun 12, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | – | – | Yes |
Other names
- University Of Maryland Charles Regional Neurology Center (Other Name)
Practice location
101 Centennial StSuite B
La Plata, MD 20646-5975
Phone 301-609-4539
Mailing address
75 Remittance Dr Dept 6554Chicago, IL 60675-6554
Phone 301-609-4539
Authorized official
Stephanie Simm
Physician Relations Specialist
3016094539
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