Healthcare Provider Details

I. General information

NPI: 1184365991
Provider Name (Legal Business Name): BMS PROFESSIONAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date: 05/13/2023
Reactivation Date: 06/01/2023

III. Provider practice location address

5525 EASTERN AVE STE 301
BALTIMORE MD
21224-2796
US

IV. Provider business mailing address

5525 EASTERN AVE STE 301
BALTIMORE MD
21224-2796
US

V. Phone/Fax

Practice location:
  • Phone: 410-732-8800
  • Fax:
Mailing address:
  • Phone: 443-703-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY SUTTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-558-4891