Healthcare Provider Details

I. General information

NPI: 1205537149
Provider Name (Legal Business Name): MRS. BARIDARA F BARIBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LA SALLE RD STE 3212ND
TOWSON MD
21286-2001
US

IV. Provider business mailing address

1616 SHADY GLEN DR
DISTRICT HEIGHTS MD
20747-1763
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-0391
  • Fax:
Mailing address:
  • Phone: 240-280-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208058
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR208058
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: