Healthcare Provider Details

I. General information

NPI: 1346112299
Provider Name (Legal Business Name): ELHAM HEDAYATPOUR BSN,RN, FNP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N CHARLES ST
BALTIMORE MD
21210-2404
US

IV. Provider business mailing address

4701 N CHARLES ST
BALTIMORE MD
21210-2404
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-0266
  • Fax:
Mailing address:
  • Phone: 410-435-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR232205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: