Healthcare Provider Details

I. General information

NPI: 1609932409
Provider Name (Legal Business Name): JUDITH FRANCIS DEBOSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH FRANCIS MD

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/10/2022
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E FAYETTE ST BCHD BUREAU OF SCHOOL HEALTH
BALTIMORE MD
21202-4715
US

IV. Provider business mailing address

1001 E FAYETTE ST BUREAU OF SCHOOL HEALTH
BALTIMORE MD
21202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-4453
  • Fax: 410-545-6636
Mailing address:
  • Phone: 410-396-4453
  • Fax: 410-545-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036114373
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD037748
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD68520
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: