Healthcare Provider Details

I. General information

NPI: 1598825044
Provider Name (Legal Business Name): SHEPPARD PRATT HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3000
  • Fax:
Mailing address:
  • Phone: 443-377-5273
  • Fax: 443-659-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number03-039
License Number StateMD

VIII. Authorized Official

Name: SUSAN KESSLER
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 410-382-8111