Healthcare Provider Details

I. General information

NPI: 1225786940
Provider Name (Legal Business Name): ATARA YEHUDIT TOSO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

3314 BANCROFT RD APT SUITE
BALTIMORE MD
21215-3103
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0350
  • Fax:
Mailing address:
  • Phone: 443-676-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: