Healthcare Provider Details

I. General information

NPI: 1497998652
Provider Name (Legal Business Name): LAURA EBNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238A BAY RIDGE AVE
ANNAPOLIS MD
21403-2832
US

IV. Provider business mailing address

2238A BAY RIDGE AVE
ANNAPOLIS MD
21403-2832
US

V. Phone/Fax

Practice location:
  • Phone: 410-635-0465
  • Fax:
Mailing address:
  • Phone: 410-635-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberD0069959
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License NumberD00699599
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0069959
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0069959
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0069959
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD0069959
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberD0069959
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: