| Provita Health | |
|
5400 Old Court Rd Randallstown MD 21133-5100 | |
| (410) 521-4211 | |
| (410) 521-0627 |
| Full Name | Provita Health |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 5400 Old Court Rd, Randallstown, Maryland |
| Authorized Official Name and Position | Elvira Pasmanik (PRESIDENT) |
| Authorized Official Contact | 4437398040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provita Health 5400 Old Court Rd Randallstown MD 21133-5100 Ph: (410) 521-4211 | Provita Health 5400 Old Court Rd Randallstown MD 21133-5100 Ph: (410) 521-4211 |
| NPI Number | 1326230343 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 02/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326230343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0059228 (Maryland) | Primary |
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