Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Maryland Healing Waters, LLC

Organization Internal Medicine Physician · NPI 1366739179

Maryland Healing Waters, LLC is an Internal Medicine Physician in Glen Burnie, Maryland. Licensed in Maryland. Registered with an NPI since 2011.

Licensed in
MD
In the registry since
2011
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1414 Crain Hwy N Ste 6A
Glen Burnie, MD 21061-9307
Phone: (410) 761-7901
Fax: (410) 761-1031
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence D25559 (MD)

Record details

NPI number1366739179
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lawrence Vidaver — Physician · (410) 761-7901
NPI enumeratedJune 30, 2011
Last updated in NPPESMay 17, 2024
Certification dateMay 17, 2024
Mailing address1414 Crain Hwy N Ste 6a, Glen Burnie, MD 21061-9307

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