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1501 S Clinton St Baltimore MD 21224-5730 | |
(866) 233-6925 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 1501 S Clinton St, Baltimore, Maryland |
Authorized Official Name and Position | Mary Jane Favazza (CEO) |
Authorized Official Contact | 4105287109 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1501 S Clinton St Baltimore MD 21224-5730 Ph: (866) 233-6925 | 1501 S Clinton St Baltimore MD 21224-5730 Ph: (866) 233-6925 |
NPI Number | 1548967128 |
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Provider Enumeration Date | 02/14/2023 |
Last Update Date | 08/08/2024 |
Identifier | Type | State | Issuer |
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1548967128 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
208000000X | Pediatrics | (* (Not Available)) | Secondary |
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