Healthcare Provider Details

I. General information

NPI: 1891991824
Provider Name (Legal Business Name): BRIAN LADLE M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHNS HOPKINS BLOOMBERG CHILDRENS CTR RM 11379 1800 ORLEANS ST
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8751
  • Fax: 410-955-0028
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0070111
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD0070111
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: