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General NPI Number Information
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NPI Number | 1700853249
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Entity Type | Individual
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Provider Name | STACEY LAURINE EADIE D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 1105 N POINT BLVD SUITE 306
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City | BALTIMORE
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State | MD
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Zip | 21224-3419
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Country | US
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Telephone | 410-285-5437
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Fax | 410-285-7333
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Provider Business Mailing Address
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Address Line | PO BOX 15444
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City | BALTIMORE
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State | MD
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Zip | 21220-0444
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Country | US
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Telephone | 410-285-5437
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Fax | 410-285-7333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H0061035
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License Number State | MD
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