Organization
BALTIMORE KETAMINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVANA MITIC CRNA (CEO)
(410) 870-5482
Entity
Organization
Contact information
Practice address
909 RIDGEBROOK RD STE 202, SPARKS, MD 21152-9476
(410) 870-5482
Mailing address
909 RIDGEBROOK RD STE 202, SPARKS, MD 21152-9476
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209047300
—
MD
Enumeration date
09/27/2022
Last updated
09/27/2022
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