Healthcare Provider Details

I. General information

NPI: 1992354930
Provider Name (Legal Business Name): TAYLOR ALEXANDRA GEYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HOWARD ST STE 300
BALTIMORE MD
21218-5909
US

IV. Provider business mailing address

1900 N HOWARD ST STE 300
BALTIMORE MD
21218-5909
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 Number20888
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: