BALTIMORE KETAMINE CLINIC NPI 1508580275

NPI Information

NPI: 1508580275
Provider Name: BALTIMORE KETAMINE CLINIC
Classification: Clinic/Center - 261QI0500X
Specialization: Infusion Therapy
Entity Type: Organization
Address: 909 RIDGEBROOK RD STE 202
SPARKS, MD
ZIP 21152
Phone: (410) 870-5482

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NPI Details

BALTIMORE KETAMINE CLINIC is an infusion therapy clinic center in Sparks, MD. BALTIMORE KETAMINE CLINIC NPI is 1508580275. The provider is registered as an organization entity type.

The provider's business location address is:

909 RIDGEBROOK RD STE 202
SPARKS, MD
ZIP 21152-476
Phone: (410) 870-5482

The provider's authorized official is Ivana Mitic .
The authorized official title is Ceo and has the following contact phone number (410) 870-5482.

The enumeration date for this NPI number is 9/27/2022 and was last updated on 9/27/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QI0500X	Clinic/Center	Infusion Therapy			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	209047300	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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