Basic Information
| Provider Information | |||||||||
| NPI: | 1043819089 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SINAI HOSPITAL OF BALTIMORE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 W BELVEDERE AVE STE 504 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106018331 | ||||||||
| FaxNumber: | 4106015389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 QUARRY LAKE DR STE 270 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106018331 | ||||||||
| FaxNumber: | 4106015389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | EFIRD | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4106017019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SINAI HOSPITAL OF BALTIMORE INC | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
No ID Information.