Douglas Bazemore
Individual provider Active NPI Contractor · Churchville, MD
NPI 1972029007 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1972029007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 3014 Cool Branch Road
Churchville, MD 21028 - Phone
- (443) 617-7277
- NPI assigned
- Aug 21, 2017
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | |||
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
3014 Cool Branch Road
Churchville, MD 21028
Mailing address
3014 Cool Branch Rd
Churchville, MD 21028-1002
Phone (443) 617-7277
Other providers in Churchville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.