Healthcare Provider Details

I. General information

NPI: 1639901655
Provider Name (Legal Business Name): VEDRANA HODZIC MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W LAKE AVE
BALTIMORE MD
21210-1240
US

IV. Provider business mailing address

806 W LAKE AVE
BALTIMORE MD
21210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 301-500-5417
  • Fax:
Mailing address:
  • Phone: 301-500-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VEDRANA HODZIC
Title or Position: OWNER
Credential: MD
Phone: 301-500-5417