Healthcare Provider Details

I. General information

NPI: 1457521791
Provider Name (Legal Business Name): MERCY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE MERCY MEDICAL CENTER DENTAL DEPT.
BALTIMORE MD
21202
US

IV. Provider business mailing address

301 ST. PAUL PLACE MERCY MEDICAL CENTER DENTAL DEPT.
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9262
  • Fax: 410-545-4253
Mailing address:
  • Phone: 410-385-3270
  • Fax: 410-545-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4233
License Number StateMD

VIII. Authorized Official

Name: SHARON HARPER
Title or Position: CLINICAL OFFICE MANAGER
Credential:
Phone: 410-385-3270