MEDICARE: SAINT AGNES HOSPITAL

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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1811125917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT AGNES HOSPITAL

Provider Business Mailing Address
First Line	:	1211 LIGHT ST APT 104
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-4365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 LIGHT ST APT 104
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-4365
Country	:	US
Telephone Number	:	443-255-0800
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	RAFAEL ALMEIDA OLIVEIRA
Credential	:
Telephone Number	:	443-255-0800

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	06/26/2009

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