Healthcare Provider Details

I. General information

NPI: 1114737681
Provider Name (Legal Business Name): MR. ELI LAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CHIPPEWA DR
BALTIMORE MD
21209-1513
US

IV. Provider business mailing address

6701 CHIPPEWA DR
BALTIMORE MD
21209-1513
US

V. Phone/Fax

Practice location:
  • Phone: 443-377-6930
  • Fax: 410-205-9493
Mailing address:
  • Phone: 443-377-6930
  • Fax: 410-205-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: