Healthcare Provider Details

I. General information

NPI: 1275908105
Provider Name (Legal Business Name): NETANEL G. SCHWOB, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD SUITE 203
BALTIMORE MD
21208-2800
US

IV. Provider business mailing address

4000 OLD COURT RD SUITE 203
BALTIMORE MD
21208-2800
US

V. Phone/Fax

Practice location:
  • Phone: 401-486-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberD0047744
License Number StateMD

VIII. Authorized Official

Name: DR. NETANEL SCHWOB
Title or Position: OWNER
Credential: M.D.
Phone: 410-486-6100