Healthcare Provider Details

I. General information

NPI: 1942849468
Provider Name (Legal Business Name): MS. ADELAIDE ELIZABETH GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ADELAIDE ELIZABETH BERTRAM

II. Dates (important events)

Enumeration Date: 01/01/2020
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

2772 LIGHTHOUSE PT E UNIT 212
BALTIMORE MD
21224-5051
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 570-574-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR209373
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR209373
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR209373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: