Healthcare Provider Details

I. General information

NPI: 1174586135
Provider Name (Legal Business Name): SAMUEL E ADLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE DEPT OF PSYCHIATRY
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

6535 N CHARLES ST SUITE 300
BALTIMORE MD
21204-5826
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5461
  • Fax: 410-601-4458
Mailing address:
  • Phone: 410-938-5252
  • Fax: 410-938-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0017404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: