Provider Demographics
NPI:1518990712
Name:SHEPPARD PRATT PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:SHEPPARD PRATT PHYSICIANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CORPORATE BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-938-3150
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3150
Mailing Address - Fax:410-938-3159
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3150
Practice Address - Fax:410-938-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC00Y734OtherMEDICARE PTAN
MD374114OtherMAMSI COMMERCIAL INS #
MD560801500Medicaid
MD814LOtherMEDICARE - SPEC LOCAITONS
MD814LOtherMEDICARE - SPEC LOCAITONS
MD560801500Medicaid
MDS676Medicare ID - Type UnspecifiedPSYCHIATRIST MEDICARE #
MDK598Medicare ID - Type UnspecifiedPHD MEDICARE GROUP #