Provider Demographics
NPI:1649484049
Name:ST. AGNES HOSPICE PHYSICIAN SVC
Entity type:Organization
Organization Name:ST. AGNES HOSPICE PHYSICIAN SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-368-2827
Mailing Address - Street 1:3421 BENSON AVE
Mailing Address - Street 2:SUITE G-100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1056
Mailing Address - Country:US
Mailing Address - Phone:410-368-2839
Mailing Address - Fax:410-368-8449
Practice Address - Street 1:3421 BENSON AVE
Practice Address - Street 2:SUITE G-100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1056
Practice Address - Country:US
Practice Address - Phone:410-368-2839
Practice Address - Fax:410-368-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1512251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based