Healthcare Provider Details

I. General information

NPI: 1417124470
Provider Name (Legal Business Name): SHERYL BAKER MARTIN OMD L.AC. RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
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:
Title or Position:
Credential:
Phone: