Provider Demographics
NPI:1962800144
Name:CHARM CITY HOUSE CALLS
Entity type:Organization
Organization Name:CHARM CITY HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRACKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:443-226-5597
Mailing Address - Street 1:3118 ABELL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3411
Mailing Address - Country:US
Mailing Address - Phone:443-226-5597
Mailing Address - Fax:
Practice Address - Street 1:3118 ABELL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3411
Practice Address - Country:US
Practice Address - Phone:443-226-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty