Organization
BALTIMORE KETAMINE CLINIC EASTERN SHORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVANA MITIC CRNP-PMH, CRNA (OWNER)
(713) 412-3462
Entity
Organization
Contact information
Practice address
2324 N ZION RD STE 113, SALISBURY, MD 21801-2576
(410) 870-5482
(410) 628-1212
Mailing address
2324 N ZION RD STE 113, SALISBURY, MD 21801-2576
(410) 870-5482
(410) 628-1212
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/09/2022
Last updated
02/17/2023
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