Individual
AUTUMN SKYE IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 ORLEANS STREET, BALTIMORE, MD 21264-4203
(410) 502-2037
(410) 955-0737
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A126865
CA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
A126865
CA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
D0101347
MD
Other
Enumeration date
04/13/2012
Last updated
08/15/2024
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