Healthcare Provider Details

I. General information

NPI: 1184990095
Provider Name (Legal Business Name): MICHAEL HOLDSWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PACA ST 6TH FLOOR, SUITE 200
BALTIMORE MD
21201-1642
US

IV. Provider business mailing address

110 S PACA ST 6TH FLOOR, SUITE 200
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8025
  • Fax: 410-328-8028
Mailing address:
  • Phone: 410-328-8025
  • Fax: 410-328-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD83243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: