Healthcare Provider Details

I. General information

NPI: 1831776285
Provider Name (Legal Business Name): CONNIE QIU MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST FL 8
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5933
  • Fax: 410-502-2309
Mailing address:
  • Phone: 410-933-2704
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0103097
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: