Provider Demographics
NPI:1184957235
Name:PASSPORT HEALTH
Entity type:Organization
Organization Name:PASSPORT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESSANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:410-727-0556
Mailing Address - Street 1:921 E FORT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5135
Mailing Address - Country:US
Mailing Address - Phone:410-727-0556
Mailing Address - Fax:410-727-0696
Practice Address - Street 1:921 E FORT AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5135
Practice Address - Country:US
Practice Address - Phone:410-727-0556
Practice Address - Fax:410-727-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053043261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health