Healthcare Provider Details

I. General information

NPI: 1942341235
Provider Name (Legal Business Name): MARCELO FERNANDO BATKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE # A4C-461 JHBMC DEPT OF PSYCHIATRY
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

4940 EASTERN AVE # A4C-461 JHBMC DEPT OF PSYCHIATRY
BALTIMORE MD
21224-2735
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0064
  • Fax: 410-550-1407
Mailing address:
  • Phone: 410-550-0064
  • Fax: 410-550-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0065524
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0065524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: