Healthcare Provider Details

I. General information

NPI: 1952357881
Provider Name (Legal Business Name): ANI HYSLOP M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S. CATON AVENUE
BALTIMORE MD
21229
US

IV. Provider business mailing address

3718 APPLEBY COURT
GLENWOOD MD
21738
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-2011
  • Fax:
Mailing address:
  • Phone: 410-489-7257
  • Fax: 301-572-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD53090
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: