Healthcare Provider Details

I. General information

NPI: 1972328292
Provider Name (Legal Business Name): CORAZON-PANES SANCHEZ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 EASTERN BLVD
BALTIMORE MD
21221-3535
US

IV. Provider business mailing address

20 CRAIGTOWN RD STE 101
PORT DEPOSIT MD
21904-1801
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-9172
  • Fax:
Mailing address:
  • Phone: 410-642-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CORAZON SANCHEZ
Title or Position: PHYSICIAN
Credential:
Phone: 443-807-3442