Healthcare Provider Details

I. General information

NPI: 1912561820
Provider Name (Legal Business Name): SARAH MARIE DERMODY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 CLARKVIEW RD STE 300
BALTIMORE MD
21209-2100
US

IV. Provider business mailing address

1427 CLARKVIEW RD STE 300
BALTIMORE MD
21209-2100
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-0414
  • Fax:
Mailing address:
  • Phone: 410-296-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberD0107488
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number334258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: