Provider Demographics
NPI:1912369661
Name:CEZAR, CAREY BRADLEY (CNM)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:BRADLEY
Last Name:CEZAR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ST PAUL PLACE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-659-2982
Mailing Address - Fax:410-332-9134
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-659-2982
Practice Address - Fax:410-332-9134
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR080474367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW86036OtherSTATE OF MARYLAND CONTROLLED AND DANGEROUS SUBSTANCES REGISTRATION