Healthcare Provider Details

I. General information

NPI: 1760885958
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS SPPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL PL TOWER 1
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL PL MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9000
  • Fax:
Mailing address:
  • Phone: 410-659-2963
  • Fax: 410-332-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN DEIBEL
Title or Position: SENIOR VP AND CFO
Credential:
Phone: 800-355-0808