Healthcare Provider Details

I. General information

NPI: 1891741112
Provider Name (Legal Business Name): ST. PAUL PLACE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 ST. PAUL PLACE 6TH FLOOR
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

PO BOX 824173
PHILADELPHIA PA
19182-4173
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9002
  • Fax: 410-783-5880
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0008372
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberD0008372
License Number StateMD

VIII. Authorized Official

Name: JUSTIN DEIBEL
Title or Position: EXECUTIVE VICE PRESIDENT & CFO
Credential:
Phone: 410-659-2905