Provider Demographics
NPI:1659556413
Name:ENDOCRINOLOGY ASSOCIATES OF BALTIMORE LLC
Entity Type:Organization
Organization Name:ENDOCRINOLOGY ASSOCIATES OF BALTIMORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-368-1370
Mailing Address - Street 1:3421 BENSON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1056
Mailing Address - Country:US
Mailing Address - Phone:410-368-1370
Mailing Address - Fax:410-368-3569
Practice Address - Street 1:3421 BENSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1056
Practice Address - Country:US
Practice Address - Phone:410-368-1370
Practice Address - Fax:410-368-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407953100Medicaid
MD905MMedicare PIN