Healthcare Provider Details

I. General information

NPI: 1053264580
Provider Name (Legal Business Name): SAINT PAUL PLACE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SOLLERS POINT RD
DUNDALK MD
21222-4647
US

IV. Provider business mailing address

301 ST PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2104
US

V. Phone/Fax

Practice location:
  • Phone: 410-288-6226
  • Fax:
Mailing address:
  • Phone: 410-659-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN DEIBEL
Title or Position: EXECUTIVE VICE PRESIDENT/CFO
Credential:
Phone: 410-659-2905