Healthcare Provider Details

I. General information

NPI: 1669933859
Provider Name (Legal Business Name): MAX COALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-659-2800
  • Fax:
Mailing address:
  • Phone: 410-659-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0101063
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: