Provider Demographics
NPI:1396509246
Name:RESTORATIVE MEDICINE AND AESTHETICS IN ANNAPOLIS
Entity type:Organization
Organization Name:RESTORATIVE MEDICINE AND AESTHETICS IN ANNAPOLIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-858-1112
Mailing Address - Street 1:1321 GENERALS HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2060
Mailing Address - Country:US
Mailing Address - Phone:410-858-1112
Mailing Address - Fax:
Practice Address - Street 1:1321 GENERALS HWY STE 303
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2060
Practice Address - Country:US
Practice Address - Phone:410-858-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty