Healthcare Provider Details

I. General information

NPI: 1013645597
Provider Name (Legal Business Name): JOHN MICHAEL PLASTER M.S., CAC-AD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N POINT BLVD STE 128
BALTIMORE MD
21224-3417
US

IV. Provider business mailing address

1111 PINE HEIGHTS AVE
BALTIMORE MD
21229-5211
US

V. Phone/Fax

Practice location:
  • Phone: 443-231-3040
  • Fax:
Mailing address:
  • Phone: 323-636-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: