Provider Demographics
NPI:1952357881
Name:HYSLOP, ANI (MD, MPH)
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:HYSLOP
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 APPLEBY COURT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738
Mailing Address - Country:US
Mailing Address - Phone:410-489-7257
Mailing Address - Fax:301-572-0999
Practice Address - Street 1:900 S. CATON AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-368-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53090208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD981400100Medicaid
MDKR47B937Medicare ID - Type Unspecified
MD981400100Medicaid