Basic Information
Provider Information | |||||||||
NPI: | 1437174059 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SINAI HOSPITAL OF BALTIMORE INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SINAI OPHTHALMOLOGY ASSOCIATES | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2401 W BELVEDERE AVE | ||||||||
Address2: | ATTN: CREDENTIALING | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212155216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106015524 | ||||||||
FaxNumber: | 4106018946 | ||||||||
Practice Location | |||||||||
Address1: | MORTON MOWER, M.D. OFF. BLDG. | ||||||||
Address2: | 2411 W. BELVEDERE AVENUE, 6TH FLOOR | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 21215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106015700 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2006 | ||||||||
LastUpdateDate: | 03/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | EFIRD | ||||||||
AuthorizedOfficialFirstName: | CHARLES | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 4106017019 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SINAI HOSPITAL OF BALTIMORE INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 30-062 | MD | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | C31152 | 01 | MD | R/R MEDICARE GROUP # | OTHER | CC3778 | 01 | MD | R/R MEDICARE GROUP # | OTHER | CB8985 | 01 | MD | R/R MEDICARE GROUP # | OTHER | CB9695 | 01 | MD | R/R MEDICARE GROUP # | OTHER |