Provider Demographics
NPI:1922079599
Name:FINE, IRA T (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:T
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10753 FALLS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4535
Mailing Address - Country:US
Mailing Address - Phone:410-583-2828
Mailing Address - Fax:410-583-2841
Practice Address - Street 1:10753 FALLS RD
Practice Address - Street 2:SUITE 225
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4535
Practice Address - Country:US
Practice Address - Phone:410-583-2828
Practice Address - Fax:410-583-2841
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015400OtherJOHNS HOPKINS EMPLOYEE HE
MD660002744OtherTRAVELERS RR MEDICARE
MD520595110OtherJOHNS HOPKINS UNIVERSITY
MD100588OtherKAISER PROVIDER #
MD41352406OtherCAREFIRST BCBS
MDT6320002OtherCAREFIRST FEDERAL PROVIDE
MDT6320002OtherCAREFIRST FEDERAL PROVIDE
MED76187Medicare UPIN