Healthcare Provider Details

I. General information

NPI: 1366548034
Provider Name (Legal Business Name): MARTHA SWEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE
BALTIMORE MD
21264-0001
US

IV. Provider business mailing address

PO BOX 64522
BALTIMORE MD
21264-4522
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD19679
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: