Healthcare Provider Details

I. General information

NPI: 1346905312
Provider Name (Legal Business Name): MIRIAM SPERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 BOSLEY AVE STE B1
TOWSON MD
21204-4302
US

IV. Provider business mailing address

7113 PHEASANT CROSS DR
BALTIMORE MD
21209-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-988-2503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR205742
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: