Healthcare Provider Details

I. General information

NPI: 1467375386
Provider Name (Legal Business Name): DEVONA N ADDISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WASHINGTON BLVD STE 630
BALTIMORE MD
21230-1728
US

IV. Provider business mailing address

1800 WASHINGTON BLVD STE 630
BALTIMORE MD
21230-1728
US

V. Phone/Fax

Practice location:
  • Phone: 410-703-1570
  • Fax:
Mailing address:
  • Phone: 410-703-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: