Healthcare Provider Details

I. General information

NPI: 1508251067
Provider Name (Legal Business Name): KATE LYNN CHO IWAMOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-500-5500
  • Fax:
Mailing address:
  • Phone: 410-500-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD85303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: