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General NPI Number Information
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NPI Number | 1497620660
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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 | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 100 E CARROLL ST
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City | SALISBURY
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State | MD
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Zip | 21801-5422
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Country | US
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Telephone | 410-332-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 301 ST PAUL PLACE MEDICAL STAFF OFFICE
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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 | 410-659-2963
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Fax | 410-332-9789
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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 | 363A00000X
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Taxonomy Name | 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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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