Healthcare Provider Details

I. General information

NPI: 1518932862
Provider Name (Legal Business Name): NEPHROLOGY CENTER OF MARYLAND, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD SUITE 3 NORTH
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD SUITE 3 NORTH
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-3775
  • Fax: 443-444-4678
Mailing address:
  • Phone: 443-444-3775
  • Fax: 443-444-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0031960
License Number StateMD

VIII. Authorized Official

Name: MARIE ROBIER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 443-444-3775