Organization
SAINT 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
301 SAINT PAUL PL, BALTIMORE, MD 21202-2102
(410) 332-9260
(410) 659-2815
Mailing address
PO BOX 824173, PHILADELPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9754
BLUE CHOICE
MD
01
—
KT93
BC / BS OF MD
MD
01
—
S186
BLUECHOICE
MD
Enumeration date
05/26/2006
Last updated
12/18/2024
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