Healthcare Provider Details

I. General information

NPI: 1659556413
Provider Name (Legal Business Name): ENDOCRINOLOGY ASSOCIATES OF BALTIMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2007
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 BENSON AVE SUITE 210
BALTIMORE MD
21227-1056
US

IV. Provider business mailing address

3421 BENSON AVE SUITE 210
BALTIMORE MD
21227-1056
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-1370
  • Fax: 410-368-3569
Mailing address:
  • Phone: 410-368-1370
  • Fax: 410-368-3569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASIF MOHAMED
Title or Position: MEMBER
Credential: M.D.
Phone: 410-368-1370