| Evernorth Care Providers - Delaware Pa | |
|
200 E Pratt St Baltimore MD 21202-6103 | |
| (773) 292-4800 | |
| (312) 564-4059 |
| Full Name | Evernorth Care Providers - Delaware Pa |
|---|---|
| Speciality | General Practice |
| Location | 200 E Pratt St, Baltimore, Maryland |
| Authorized Official Name and Position | Grace Blue (CREDENTIALING SR. MANAGER) |
| Authorized Official Contact | 7732924800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evernorth Care Providers - Delaware Pa 730 Cool Springs Blvd Ste 500 Franklin TN 37067-7331 Ph: (773) 292-4800 | Evernorth Care Providers - Delaware Pa 200 E Pratt St Baltimore MD 21202-6103 Ph: (773) 292-4800 |
| NPI Number | 1063284032 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 11/17/2023 |
| Medicare PECOS PAC ID | 6002217973 |
|---|---|
| Medicare Enrollment ID | O20231206001646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063284032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Shannon Alsop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003043803 PECOS PAC ID: 7517121742 Enrollment ID: I20230330000155 |
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