Healthcare Provider Details

I. General information

NPI: 1366434227
Provider Name (Legal Business Name): LAUREN B. RICHTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR SECOND FLOOR
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

29 S PACA ST
BALTIMORE MD
21201-1771
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-6361
  • Fax: 410-448-1873
Mailing address:
  • Phone: 410-448-6772
  • Fax: 410-448-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO0036547
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: