Healthcare Provider Details

I. General information

NPI: 1841440880
Provider Name (Legal Business Name): SRD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 717-428-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIM ERSKINE
Title or Position: BILLING MANAGER
Credential:
Phone: 717-428-0552