Provider Demographics
NPI:1790910495
Name:SINAI HOSPITAL OF BALTIMORE, INC
Entity Type:Organization
Organization Name:SINAI HOSPITAL OF BALTIMORE, INC
Other - Org Name:SINAI CLINICAL PROFESSIONALS RD D/B/A CLINICAL ASSOCIATES RD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-5524
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5523
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-296-5300
Practice Address - Fax:410-494-1302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINAI HOSPITAL OF BALTIMORE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132958ZD2XMedicare UPIN
MD157676Medicare UPIN