Healthcare Provider Details

I. General information

NPI: 1154942969
Provider Name (Legal Business Name): SARAH ELIZABETH MUDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST
BALTIMORE MD
21287-0013
US

IV. Provider business mailing address

1650 ORLEANS ST
BALTIMORE MD
21287-0013
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-2491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMTL500001737
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMTL500001737
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: