Healthcare Provider Details

I. General information

NPI: 1689459489
Provider Name (Legal Business Name): HEART OWN MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GREENMOUNT AVE
BALTIMORE MD
21218-4721
US

IV. Provider business mailing address

3905 EDNOR RD
BALTIMORE MD
21218-2054
US

V. Phone/Fax

Practice location:
  • Phone: 443-827-3802
  • Fax:
Mailing address:
  • Phone: 443-827-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SYDNOR
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 443-827-3802