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	3960	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	:	1922152578
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	:	4819 WALDEN LN STE 4880
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4826
Country	:	US
Telephone Number	:	240-667-1423
Fax Number	:	240-764-6764

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	04/28/2026

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