| St Agnes Diabetes Prevention Program | |
|
900 Caton Ave Baltimore MD 21229-5201 | |
| (667) 234-3244 | |
| Not Available |
| Full Name | St Agnes Diabetes Prevention Program |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 900 Caton Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Edward R Lovern (PRESIDENT/CEO) |
| Authorized Official Contact | 6672342105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Agnes Diabetes Prevention Program 3585 Washington Blvd Halethorpe MD 21227-1676 Ph: (667) 234-2149 | St Agnes Diabetes Prevention Program 900 Caton Ave Baltimore MD 21229-5201 Ph: (667) 234-3244 |
| NPI Number | 1780225326 |
|---|---|
| Provider Enumeration Date | 10/04/2019 |
| Last Update Date | 06/23/2021 |
| Certification Date | 06/23/2021 |
| Medicare PECOS PAC ID | 9830092733 |
|---|---|
| Medicare Enrollment ID | O20191202002420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780225326 | NPI | - | NPPES |
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