Healthcare Provider Details

I. General information

NPI: 1336053818
Provider Name (Legal Business Name): MICHELLE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MR. KENNETH STEWART III

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 E FEDERAL ST
BALTIMORE MD
21213-3910
US

IV. Provider business mailing address

2902 E FEDERAL ST
BALTIMORE MD
21213-3910
US

V. Phone/Fax

Practice location:
  • Phone: 443-928-5100
  • Fax:
Mailing address:
  • Phone: 443-928-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: