Provider Demographics
NPI:1588602015
Name:PINKSTAFF, SALLY MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MAE
Last Name:PINKSTAFF
Suffix:
Gender:F
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-558-5234
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-5961
Practice Address - Fax:410-601-9390
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58652207RE0101X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110248857OtherR/R MEDICARE PROVIDER #
MD362230400Medicaid
MDCA8374OtherR/R MEDICARE GROUP #
MD174365ZAC3Medicare PIN
MDC44946Medicare UPIN
MDS578F503Medicare PIN