Healthcare Provider Details

I. General information

NPI: 1518990712
Provider Name (Legal Business Name): SHEPPARD PRATT PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3150
  • Fax: 410-938-3159
Mailing address:
  • Phone: 410-938-3150
  • Fax: 410-938-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE B. KATZ
Title or Position: VP CORPORATE BUSINESS DEVELOPMENT
Credential:
Phone: 410-938-3150