Healthcare Provider Details

I. General information

NPI: 1073653002
Provider Name (Legal Business Name): MARY ELIZABETH AICHELMANN-REIDY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WEST BALTIMORE STREET, ROOM, 4209, DEPARTMENT OF PERIODONTICS
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W. BALTIMORE STREET, ROOM, 4209, DEPARTMENT OF PERIODONTICS
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7153
  • Fax:
Mailing address:
  • Phone: 410-706-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number34
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: