MEDICARE: CAROLINE POFF PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R215098	MD

General Provider Information

NPI Number	:	1396566725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE POFF PMHNP

Provider Business Mailing Address
First Line	:	6340 SECURITY BLVD STE 100 #1345
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207
Country	:	US
Telephone Number	:
Fax Number	:	410-826-3934

Provider Business Practice Location Address
First Line	:	428 GUN RD
Second Line	:
City	:	HALETHORPE
State	:	MD
Zip	:	21227-3823
Country	:	US
Telephone Number	:	443-668-4441
Fax Number	:	410-826-3934

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

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	05/08/2026

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