Healthcare Provider Details

I. General information

NPI: 1982948543
Provider Name (Legal Business Name): CHANA RICHTER MD, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANA LIEBERMAN

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GREENSPRING AVE
BALTIMORE MD
21211-1353
US

IV. Provider business mailing address

3504 OVERBROOK RD
BALTIMORE MD
21208-4317
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-2600
  • Fax:
Mailing address:
  • Phone: 516-200-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0088953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: