Healthcare Provider Details

I. General information

NPI: 1649306762
Provider Name (Legal Business Name): NORA C. MEENAGHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE POB # 912
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9653
  • Fax: 410-783-5888
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD66200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: