Healthcare Provider Details

I. General information

NPI: 1093007056
Provider Name (Legal Business Name): ANNA C SICK-SAMUELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA C SICK M.D., M.P.H

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N WOLFE ST ROOM 3150
BALTIMORE MD
21287-0011
US

IV. Provider business mailing address

200 N WOLFE ST ROOM 3150
BALTIMORE MD
21287-0011
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-3917
  • Fax: 410-614-1491
Mailing address:
  • Phone: 410-614-3917
  • Fax: 410-614-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD457202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: