Organization
ST PAUL PLACE SPECIALISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DEIBEL (EXECUTIVE VICE PRESIDENT & CFO)
(410) 659-2905
Entity
Organization
Contact information
Practice address
227 SAINT PAUL PLACE, 4TH FLOOR, BALTIMORE, MD 21202-2001
(410) 783-5858
(410) 783-5864
Mailing address
PO BOX 824173, PHILADELPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165L
MEDICARE
MD
01
—
9754
BLUE CHOICE
MD
01
—
KG 65
BC/BS OF MARYLAND
MD
01
—
S 186
BLUE CHOICE
MD
Enumeration date
06/08/2006
Last updated
12/18/2024
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