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General NPI Number Information
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NPI Number | 1891741112
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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 | 05/26/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 227 ST. PAUL PLACE 6TH FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21202-2001
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Country | US
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Telephone | 410-332-9002
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Fax | 410-783-5880
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Provider Business Mailing Address
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Address Line | PO BOX 824173
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City | PHILADELPHIA
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State | PA
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Zip | 19182-4173
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Country | US
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Telephone |
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Fax |
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | D0008372
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License Number State | MD
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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 | D0008372
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License Number State | MD
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