Healthcare Provider Details

I. General information

NPI: 1720014269
Provider Name (Legal Business Name): MARYLAND ASTHMA AND ALLERGY CENTER CHTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 QUARRY LAKE DRIVE SUITE 100
BALTIMORE MD
21209-1306
US

IV. Provider business mailing address

2800 QUARRY LAKE DRIVE SUITE 100
BALTIMORE MD
21209-1306
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2000
  • Fax: 410-486-0825
Mailing address:
  • Phone: 410-486-2000
  • Fax: 410-486-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0046941
License Number StateMD

VIII. Authorized Official

Name: DR. PRASAD M NATARAJ
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 410-486-2000