Healthcare Provider Details

I. General information

NPI: 1740485671
Provider Name (Legal Business Name): SCOTT ROBERT PEKRUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/21/2016
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: 410-938-3000
  • Fax: 410-938-5131
Mailing address:
  • Phone: 410-938-3000
  • Fax: 410-938-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301090427
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301090427
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number4301090427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: