Provider Demographics
NPI:1205848694
Name:EHRENREICH, MARK JAY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAY
Last Name:EHRENREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-5881
Mailing Address - Fax:410-328-8552
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:3RD FLR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:410-328-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD338942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE27460Medicare UPIN
MDW082Medicare PIN