Provider Demographics
NPI:1447567466
Name:CAROLYN J PASS, M.D., P.A.
Entity Type:Organization
Organization Name:CAROLYN J PASS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-525-1515
Mailing Address - Street 1:1001 PINE HEIGHTS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5208
Mailing Address - Country:US
Mailing Address - Phone:410-525-1515
Mailing Address - Fax:
Practice Address - Street 1:1001 PINE HEIGHTS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5208
Practice Address - Country:US
Practice Address - Phone:410-525-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0010952207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082521200Medicaid
MDC49055Medicare UPIN
MD6619Medicare PIN