| |
2510 Saint Paul St Ste 1 Baltimore MD 21218-4760 | |
(410) 246-4876 | |
(410) 528-4513 |
Full Name | |
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Speciality | Internal Medicine - Infectious Disease |
Location | 2510 Saint Paul St Ste 1, Baltimore, Maryland |
Authorized Official Name and Position | Lyle Honig Mojica (CFO) |
Authorized Official Contact | 3238605305 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6255 W Sunset Blvd Los Angeles CA 90028-7403 Ph: (323) 860-5244 | 2510 Saint Paul St Ste 1 Baltimore MD 21218-4760 Ph: (410) 246-4876 |
NPI Number | 1417573981 |
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Provider Enumeration Date | 06/22/2020 |
Last Update Date | 03/06/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417573981 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
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