=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427437425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINAI HOSPITAL OF BALTIMORE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2015
-----------------------------------------------------
Last Update Date | 07/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 QUARRY LAKE DR SUITE 240
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-469-5522
-----------------------------------------------------
Fax | 410-469-5523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 QUARRY LAKE DR SUITE 240
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-469-5522
-----------------------------------------------------
Fax | 410-469-5523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | BARBARA EPKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-601-5123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------