Healthcare Provider Details

I. General information

NPI: 1093869679
Provider Name (Legal Business Name): SHEPPARD PRATT HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 ASPEN HILL RD
ROCKVILLE MD
20853-3709
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-3451
  • Fax: 301-933-3330
Mailing address:
  • Phone: 410-938-3000
  • Fax: 410-938-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number43
License Number StateMD

VIII. Authorized Official

Name: MS. BONNIE B. KATZ
Title or Position: VP CORPORATE BUSINESS DEVELOPMENT
Credential:
Phone: 410-938-3150