MEDICARE: SHEPPARD PRATT HEALTH SYSTEM, INC.

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	PENDING	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629247051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPPARD PRATT HEALTH SYSTEM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 79751
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-0751
Country	:	US
Telephone Number	:	410-517-5551
Fax Number	:	443-659-2429

Provider Business Practice Location Address
First Line	:	610 E DIAMOND AVE STE E
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-5332
Country	:	US
Telephone Number	:	301-330-4359
Fax Number	:	301-330-0533

Authorized Official
Title or Position	:	COMPLIANCE
Name	:	JESSICA DORSEY
Credential	:
Telephone Number	:	410-517-5551

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	04/22/2026

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