Healthcare Provider Details

I. General information

NPI: 1336337906
Provider Name (Legal Business Name): STEVEN MICHAEL SWEET PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST FL 6 JOHNS HOPKINS OUTPATIENT CENTER
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

7253 AMBASSADOR RD STE 200 ADVANCED RADIOLOGY
BALTIMORE MD
21244-2710
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-9827
  • Fax: 410-955-6526
Mailing address:
  • Phone: 410-787-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC03609
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC03609
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: