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General NPI Number Information
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NPI Number | 1326351206
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Entity Type | Organization
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Legal Business Name | ST. PAUL PLACE SPECIALISTS, INC.
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 227 ST. PAUL PLACE 5TH FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21202-2102
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Country | US
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Telephone | 410-332-9330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 824173
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City | PHILADEPHIA
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State | PA
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Zip | 19182-4173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT & CFO
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Name | JUSTIN DEIBEL
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Credential |
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Telephone | 410-659-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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