Davis, Charlene T

Davis, Charlene T is an individual health care provider with primary practice located at 707 N Broadway , Baltimore MD 21205-1832. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Davis, Charlene T can be contacted via phone (443) 923-9200.

Contact Information

Primary practice address
707 N Broadway Baltimore MD 21205-1832
Phone: (443) 923-9200
Fax: (443) 923-9405
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X R045095 Maryland

Profile Details

NPI number 1336297084
LBN Legal business name Davis, Charlene T
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 8th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336297084 NPPES
Maryland Other 54288001 CARE FIRST BC BS
Maryland MEDICAID 248209600 CARE FIRST BC BS

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