MEDICARE: MARYLAND ASTHMA AND ALLERGY CENTER CHTD

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	174400000X	Specialist	D0046941	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	:	1720014269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND ASTHMA AND ALLERGY CENTER CHTD

Provider Business Mailing Address
First Line	:	2800 QUARRY LAKE DRIVE
Second Line	:	SUITE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21209-1306
Country	:	US
Telephone Number	:	410-486-2000
Fax Number	:	410-486-0825

Provider Business Practice Location Address
First Line	:	2800 QUARRY LAKE DRIVE
Second Line	:	SUITE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21209-1306
Country	:	US
Telephone Number	:	410-486-2000
Fax Number	:	410-486-0825

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. PRASAD M NATARAJ
Credential	:	M.D.
Telephone Number	:	410-486-2000

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/02/2015

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