Healthcare Provider Details

I. General information

NPI: 1417987181
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST SUITE 606
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

6565 N CHARLES ST SUITE 606
BALTIMORE MD
21204-6800
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-0160
  • Fax: 410-538-0166
Mailing address:
  • Phone: 410-583-0160
  • Fax: 410-538-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: CAROLE CHEATHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-583-0160