Healthcare Provider Details

I. General information

NPI: 1497893762
Provider Name (Legal Business Name): EMMANUEL DAVID BRAVOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST NELSON 2 -132
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST NELSON 2-132
BALTIMORE MD
21287
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5608
  • Fax:
Mailing address:
  • Phone: 410-955-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD67473
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD0067473
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: