Healthcare Provider Details

I. General information

NPI: 1205095593
Provider Name (Legal Business Name): JULIA A. WISNIEWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date: 04/08/2022
Reactivation Date: 05/17/2022

III. Provider practice location address

314 WYNDHURST AVE
BALTIMORE MD
21210-2416
US

IV. Provider business mailing address

201 WOODLAWN RD
BALTIMORE MD
21210-2546
US

V. Phone/Fax

Practice location:
  • Phone: 410-717-5012
  • Fax: 410-413-0263
Mailing address:
  • Phone: 410-717-5012
  • Fax: 410-413-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0088400
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245804
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101247902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: