Healthcare Provider Details

I. General information

NPI: 1952418535
Provider Name (Legal Business Name): MARYLAND SPINE CENTER CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST PAUL PLACE SPINE CENTER, LOWER LEVEL
BALTIMORE MD
21202
US

IV. Provider business mailing address

PO BOX 418375
BOSTON MA
02241-8375
US

V. Phone/Fax

Practice location:
  • Phone: 410-539-3434
  • Fax: 410-366-2202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES EDWARDS, II
Title or Position: TITLE
Credential:
Phone: 410-659-2802