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General NPI Number Information
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NPI Number | 1699027219
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Entity Type | Organization
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Legal Business Name | SHEPPARD PRATT HEALTH SYSTEM, INC.
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 12039 REISTERSTOWN RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3042
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Country | US
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Telephone | 410-526-5000
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Fax | 410-526-7631
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Provider Business Mailing Address
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Address Line | 12039 REISTERSTOWN RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3042
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Country | US
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Telephone | 410-526-5000
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Fax | 410-526-7631
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Authorized Official
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Title or Position | VP BUSINESS DEV AND SUPPORT OPS
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Name | MS. BONNIE B. KATZ
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Credential |
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Telephone | 410-938-3154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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