Healthcare Provider Details

I. General information

NPI: 1215849856
Provider Name (Legal Business Name): ARTIS T ZACHARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 N ELLAMONT ST
BALTIMORE MD
21216-1909
US

IV. Provider business mailing address

2528 N ELLAMONT ST
BALTIMORE MD
21216-1909
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-5297
  • Fax:
Mailing address:
  • Phone: 443-449-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALM0989
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: