Healthcare Provider Details

I. General information

NPI: 1609757822
Provider Name (Legal Business Name): PLAT1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

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 TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIA WISNIEWSKI
Title or Position: PHYSICIAN
Credential: MD
Phone: 410-717-5012