Healthcare Provider Details

I. General information

NPI: 1285778464
Provider Name (Legal Business Name): AMY JO MCCLOSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E UNIVERSITY PKWY EMERGENCY DEPT
BALTIMORE MD
21218-2843
US

IV. Provider business mailing address

110 S PACA ST EMERGENCY MEDICINE, 6TH FLOOR
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8025
  • Fax: 410-328-8028
Mailing address:
  • Phone: 410-554-2626
  • Fax: 410-328-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0066212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: