Healthcare Provider Details

I. General information

NPI: 1689832800
Provider Name (Legal Business Name): MARIA JIMENA GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST CMCS 1102
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64316
BALTIMORE MD
21264-4316
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5883
  • Fax: 410-955-0229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD438094
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberD80140
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: