Healthcare Provider Details

I. General information

NPI: 1528220894
Provider Name (Legal Business Name): AMANDA RAE SQUARE M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RAE SANDOVAL M.D.

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WADE AVE
CATONSVILLE MD
21228-4663
US

IV. Provider business mailing address

55 WADE AVE
CATONSVILLE MD
21228-4663
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-7744
  • Fax: 410-402-7678
Mailing address:
  • Phone: 410-402-7744
  • Fax: 410-402-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0080907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: