Upper Crossroads Medical Group

Key facts

NPI: 1104290261
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Physician 208D00000X
Legal business name: UPPER CROSSROADS MEDICAL GROUP
Practice address: 2412 Baldwin Mill Rd
Fallston, MD 21047
Phone: (410) 557-9191
Fax: (410) 557-9191
NPI assigned: Nov 30, 2015
Organization subpart: No

Authorized official

Name: Mrs. Salvacion Garin Lazatin, M.D. NPI 1740329283
Title: Physician/Partner
Phone: (410) 557-9191

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Salvacion Garin Lazatin, MD General Practice Physician · Fallston, MD · NPI 1740329283

Medicare reassignment NPD Authorized official GENERAL PRACTICE · MD
Benedicto Serafica Garin, M.D. General Practice Physician · Baltimore, MD · NPI 1952406043

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MD

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20160726001284	MD	Part B Supplier - Clinic/Group Practice	8224321401	Receives reassigned benefits from 1 practitioner Practice locations: Fallston, MD

National Provider Directory

Locations

2412 Baldwin Mill Rd
Fallston, MD 21047
Phone (410) 557-9191

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Physician Group: 193400000X SINGLE SPECIALTY GROUP	208D00000X			Yes

Addresses

Primary practice location

2412 Baldwin Mill Rd
Fallston, MD 21047

Mailing address

2412 Baldwin Mill Rd
Fallston, MD 21047
Phone (410) 557-9191

Other providers in Fallston, MD

All providers in Fallston, MD · General Practice Physician in Maryland

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.