Provider Demographics
NPI:1881646792
Name:CODORI, NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:CODORI
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 1:100 PARK LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2327
Mailing Address - Country:US
Mailing Address - Phone:410-467-9692
Mailing Address - Fax:
Practice Address - Street 1:401 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0016
Practice Address - Country:US
Practice Address - Phone:410-955-7584
Practice Address - Fax:410-614-3643
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44983207P00000X
MDD004493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD049061000Medicaid
MDS80642PPMedicare ID - Type Unspecified
MDF74115Medicare UPIN
MD049061000Medicaid