Healthcare Provider Details

I. General information

NPI: 1528202140
Provider Name (Legal Business Name): DEANNA JO FRIEDMAN-KLABANOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 W BALTIMORE ST RM 480
BALTIMORE MD
21201-1509
US

IV. Provider business mailing address

685 W BALTIMORE ST RM 480
BALTIMORE MD
21201-1509
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-8695
  • Fax:
Mailing address:
  • Phone: 410-706-8695
  • Fax: 410-706-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53696
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64082
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0088021
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: