Healthcare Provider Details

I. General information

NPI: 1225413388
Provider Name (Legal Business Name): PASSPORT HEALTH HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E FORT AVE SUITE 100
BALTIMORE MD
21230-5134
US

IV. Provider business mailing address

921 E FORT AVE SUITE 100
BALTIMORE MD
21230-5134
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: FRAN LESSANS
Title or Position: PRESIDENT
Credential:
Phone: 888-909-6551