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General NPI Number Information
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NPI Number | 1538964374
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Entity Type | Organization
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Legal Business Name | PORTAL HEALTH LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 7939 HONEYGO BLVD STE 208
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City | BALTIMORE
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State | MD
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Zip | 21236-5992
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Country | US
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Telephone | 410-961-0844
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Fax |
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Provider Business Mailing Address
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Address Line | 28 HADDINGTON RD
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City | TIMONIUM
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State | MD
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Zip | 21093-5719
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Country | US
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Telephone | 410-961-0844
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ZELBESA MACK
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Credential | CRNP
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Telephone | 410-961-0844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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