Healthcare Provider Details

I. General information

NPI: 1134352206
Provider Name (Legal Business Name): DENNIS ODIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD SUITE 200
BALTIMORE MD
21237-4329
US

IV. Provider business mailing address

9106 PHILADELPHIA RD SUITE 200
BALTIMORE MD
21237-4329
US

V. Phone/Fax

Practice location:
  • Phone: 410-780-1980
  • Fax: 410-780-1984
Mailing address:
  • Phone: 410-780-1980
  • Fax: 410-780-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DENNIS H. ODIE
Title or Position: OWNER
Credential: M.D.
Phone: 410-780-1980