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General NPI Number Information
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NPI Number | 1558825307
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Entity Type | Organization
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Legal Business Name | IDEAL ENDOCRINOLOGY LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 3000 CHESTNUT AVE STE 202
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City | BALTIMORE
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State | MD
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Zip | 21211-2794
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Country | US
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Telephone | 443-842-4825
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CHARLESBROOKE RD
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City | BALTIMORE
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State | MD
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Zip | 21212-1205
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Country | US
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Telephone | 443-847-5511
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | DR. CORINA CORNELIA FRATILA
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Credential | MD
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Telephone | 443-847-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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