Healthcare Provider Details

I. General information

NPI: 1851861421
Provider Name (Legal Business Name): ALAGRA S BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N. HOWARD STREET SUITE 300
BALTIMORE MD
21218
US

IV. Provider business mailing address

1900 N. HOWARD STREET SUITE 300
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-6742
  • Fax: 443-773-5624
Mailing address:
  • Phone: 443-438-6742
  • Fax: 443-773-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23603
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: