Provider Demographics
NPI:1538349923
Name:PERSONAL HEALTHCARE PROVIDERS, LLC
Entity type:Organization
Organization Name:PERSONAL HEALTHCARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:QUEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-616-7970
Mailing Address - Street 1:10755 FALLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4522
Mailing Address - Country:US
Mailing Address - Phone:410-616-7970
Mailing Address - Fax:
Practice Address - Street 1:10755 FALLS RD STE 300
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4522
Practice Address - Country:US
Practice Address - Phone:410-616-7970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI383Medicare PIN
MDG83056Medicare UPIN