Healthcare Provider Details

I. General information

NPI: 1205799202
Provider Name (Legal Business Name): AMY C GHADIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 ROLAND AVE
BALTIMORE MD
21204-3529
US

IV. Provider business mailing address

3151 SLIPPERY ELM CT
WESTMINSTER MD
21157-7523
US

V. Phone/Fax

Practice location:
  • Phone: 410-246-2659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR229942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: