Provider Demographics
NPI:1184847865
Name:CARLISLE, EMILY STREYER (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:STREYER
Last Name:CARLISLE
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:PO BOX 64362
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4362
Mailing Address - Country:US
Mailing Address - Phone:410-254-2740
Mailing Address - Fax:
Practice Address - Street 1:1830 E MONUMENT ST
Practice Address - Street 2:SUITE 6-100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0020
Practice Address - Country:US
Practice Address - Phone:410-955-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0390200000X
MDD70999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036175500Medicaid
MD036175500Medicaid