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 ST. PAUL PLACE, 5TH FLOOR, BALTIMORE, MD 21202-2102
(410) 332-9330
Mailing address
PO BOX 824173, PHILADEPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165 L
MEDICARE ID-TYPE UNSPECIFIED
MD
01
—
9754
BLUE CHOICE
MD
01
—
KT 93
BC/BS OF MD
MD
Enumeration date
07/20/2010
Last updated
12/18/2024
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