Healthcare Provider Details

I. General information

NPI: 1285248211
Provider Name (Legal Business Name): LAUREN MENDELSOHN-LEVIN, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 GRANITE RIDGE CT
BALTIMORE MD
21209-3856
US

IV. Provider business mailing address

6905 GRANITE RIDGE CT
BALTIMORE MD
21209-3856
US

V. Phone/Fax

Practice location:
  • Phone: 410-575-1926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN MENDELSOHN-LEVIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 410-575-1926