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NPI Code Detail

MEDICARE: EBONY S TATE CNM

MEDICARE: EBONY S TATE CNM
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
1367A00000XAdvanced Practice Midwife109NC

General Provider Information

NPI Number : 1558381228
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY S TATE CNM
Provider Business Mailing Address
First Line : 4701 SANGAMORE RD STE N100
Second Line : PO BOX 367
City : BETHESDA
State : MD
Zip : 20816-2558
Country : US
Telephone Number : 914-919-9200
Fax Number :
Provider Business Practice Location Address
First Line : 4701 SANGAMORE RD STE N100
Second Line :
City : BETHESDA
State : MD
Zip : 20816-2558
Country : US
Telephone Number : 914-919-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 09/23/2025

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Directions to “ EBONY S TATE CNM” Practice Location

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