Maryland Healing Waters, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D25559 Issued in MD

Legal business name

MARYLAND HEALING WATERS, LLC

Practice address

2506 Larryvale Rd
Baltimore, MD 21209-3206

Phone

(410) 761-7901

Fax

(410) 761-1031

NPI assigned

Jun 30, 2011

Last updated

Sep 15, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lawrence Vidaver, MDNPI 1578778585

Title

Physician

Phone

(410) 761-7901

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lawrence Vidaver, MD

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1578778585
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1366739179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 LARRYVALE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093206",
            "telephone_number": "410-761-7901",
            "fax_number": "410-761-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 LARRYVALE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093206",
            "telephone_number": "410-761-7901",
            "fax_number": "410-761-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND HEALING WATERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "VIDAVER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "410-761-7901",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D25559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryland General Hospital, Inc.
• Maryland General Hospital, Inc. (UMMC MTC Center for Addiction Medicine)
• Maryland General Hospital, Inc. (UMMC Midtown Campus Pharmacy)
• Maryland General Professional Practices Inc.
• Maryland Group Faculty Practice LLC
• Maryland Health Care Resources
• Maryland Health Care Resources
• Maryland Health One, Inc.
• Maryland Health Sciences, Inc.
• Maryland Healthcare Associates

• Internal Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare 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.