Healthcare Provider Details

I. General information

NPI: 1770291692
Provider Name (Legal Business Name): FAMILY TIME PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

IV. Provider business mailing address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-8632
  • Fax: 410-243-0470
Mailing address:
  • Phone: 410-243-8632
  • Fax: 410-243-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL SPAR
Title or Position: OWNER
Credential: CRNP
Phone: 410-243-8632