Healthcare Provider Details

I. General information

NPI: 1841501632
Provider Name (Legal Business Name): BETTY HERTZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 BELAIR ROAD OVERLEA HEART CENTER
BALTIMORE MD
21236
US

IV. Provider business mailing address

301 ST PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-663-6986
  • Fax:
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR065777
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: