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
3501 ST. PAUL STREET, SUITE 143, BALTIMORE, MD 21218
(410) 235-0506
(410) 467-3159
Mailing address
PO BOX 824173, PHILADELPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165 L
MEDICARE, ID-TYPE UNSPECIFIED
MD
01
—
9754
BLUE CHOICE
MD
01
—
LT35
BC/BS OF MARYLAND
—
Enumeration date
07/20/2010
Last updated
12/18/2024
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