Provider Demographics
NPI:1316474042
Name:CHARM CITY NATURAL HEALTH
Entity type:Organization
Organization Name:CHARM CITY NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAPS
Authorized Official - Middle Name:JANIS GATES
Authorized Official - Last Name:PADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:443-835-1268
Mailing Address - Street 1:4800 ROLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2393
Mailing Address - Country:US
Mailing Address - Phone:443-835-1268
Mailing Address - Fax:844-654-7169
Practice Address - Street 1:4800 ROLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2393
Practice Address - Country:US
Practice Address - Phone:443-835-1268
Practice Address - Fax:844-654-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDJ0000002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty