Healthcare Provider Details

I. General information

NPI: 1235722851
Provider Name (Legal Business Name): BELVEDERE MEDISPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E BELVEDERE AVE STE A
BALTIMORE MD
21212-3701
US

IV. Provider business mailing address

524 E BELVEDERE AVE STE A
BALTIMORE MD
21212-3701
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7168
  • Fax:
Mailing address:
  • Phone: 443-438-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINETTE EKE
Title or Position: COFOUNDER
Credential: NP
Phone: 443-928-7707