Healthcare Provider Details

I. General information

NPI: 1326351206
Provider Name (Legal Business Name): ST. PAUL PLACE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 ST. PAUL PLACE 5TH FLOOR
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

PO BOX 824173
PHILADEPHIA PA
19182-4173
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DEIBEL
Title or Position: EXECUTIVE VICE PRESIDENT & CFO
Credential:
Phone: 410-659-2905