Healthcare Provider Details

I. General information

NPI: 1033391446
Provider Name (Legal Business Name): JANIS LACOVARA, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 OSLER DR SUITE 207
BALTIMORE MD
21204-7736
US

IV. Provider business mailing address

7505 OSLER DR SUITE 207
BALTIMORE MD
21204-7736
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-2022
  • Fax: 410-337-0425
Mailing address:
  • Phone: 410-337-2022
  • Fax: 410-337-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0039016
License Number StateMD

VIII. Authorized Official

Name: JANIS LACOVARA
Title or Position: DOCTOR
Credential: M.D.
Phone: 410-337-2022