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
227 ST. PAUL PLACE, 6TH FLOOR, BALTIMORE, MD 21202-2001
(410) 332-9002
(410) 783-5880
Mailing address
PO BOX 824173, PHILADELPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
D0008372
MD
207VX0201X
Gynecologic Oncology Physician
Primary
D0008372
MD
363L00000X
Nurse Practitioner
—
—
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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