Healthcare Provider Details

I. General information

NPI: 1215255120
Provider Name (Legal Business Name): FIRST STEP HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N CHARLES ST
BALTIMORE MD
21218-5128
US

IV. Provider business mailing address

2305 N CHARLES ST
BALTIMORE MD
21218-5128
US

V. Phone/Fax

Practice location:
  • Phone: 410-779-6920
  • Fax: 410-779-6918
Mailing address:
  • Phone: 410-779-6920
  • Fax: 410-779-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0058521
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00933
License Number StateMD

VIII. Authorized Official

Name: MR. RON R. OWENS
Title or Position: C.E.O./PRESIDENT
Credential:
Phone: 410-779-6920