BALTIMORE KETAMINE CLINIC NPI 1972145381

NPI Information

  • NPI: 1972145381
  • Provider Name: BALTIMORE KETAMINE CLINIC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • CLIA Number: 21D2146226
  • Address: 909 RIDGEBROOK RD STE 202
    SPARKS GLENCOE, MD
    ZIP 21152
  • Phone: (410) 870-5482

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NPI Details

BALTIMORE KETAMINE CLINIC is a psychiatric/mental health nurse practitioner in Sparks Glencoe, MD. BALTIMORE KETAMINE CLINIC NPI is 1972145381. The provider is registered as an organization entity type.

The provider's business location address is:

909 RIDGEBROOK RD STE 202
SPARKS GLENCOE, MD
ZIP 21152-476
Phone: (410) 870-5482
Fax: (410) 628-1212

The provider's authorized official is Ivana Mitic .
The authorized official title is Group Owner and has the following contact phone number (713) 412-3462.

The CLIA number assigned to this NPI record is 21D2146226 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/17/2019 and was last updated on 5/15/2025.

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
1261QI0500XClinic/CenterInfusion TherapyNo
2363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

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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