=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326480716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DINA RECHTHAND PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2013
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 SMITH AVE SUITE 207
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-358-4243
-----------------------------------------------------
Fax | 410-358-1016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 SMITH AVE SUITE 207
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-358-4243
-----------------------------------------------------
Fax | 410-358-1016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | C0005096
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------