Provider Demographics
NPI:1417124470
Name:MARTIN, SHERYL BAKER (OMD LAC RN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:BAKER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OMD LAC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KENILWORTH DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2334
Mailing Address - Country:US
Mailing Address - Phone:410-828-3585
Mailing Address - Fax:410-828-8674
Practice Address - Street 1:658 KENILWORTH DR STE 206
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2334
Practice Address - Country:US
Practice Address - Phone:410-828-3585
Practice Address - Fax:410-828-8674
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00452171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist