MEDICARE: IFE SEMPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management	CERT. HAIR LOSS SPEC	GA

General Provider Information

NPI Number	:	1184091126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFE SEMPER

Provider Business Mailing Address
First Line	:	2141 MOUNT HOLLY ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2430
Country	:	US
Telephone Number	:	443-325-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 MOUNT HOLLY ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2430
Country	:	US
Telephone Number	:	443-325-3715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	08/25/2015

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Directions to “ IFE SEMPER ” Practice Location

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