Healthcare Provider Details

I. General information

NPI: 1134209828
Provider Name (Legal Business Name): MARYLAND CENTER FOR INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 KENILWORTH DR STE 206
BALTIMORE MD
21204-2334
US

IV. Provider business mailing address

658 KENILWORTH DR STE 206
BALTIMORE MD
21204-2334
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-3585
  • Fax: 410-828-8674
Mailing address:
  • Phone: 410-828-3585
  • Fax: 410-828-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00452
License Number StateMD

VIII. Authorized Official

Name: SHERYL BAKER MARTIN
Title or Position: CEO, CLINICAL DIRECTOR
Credential: OMD, L.AC. RN
Phone: 410-969-0981