Individual provider Active NPI

Lauren Palank Sobotka, MSN, RN, CPNP-PC

  • Primary Care Nurse Practitioner
  • Hunt Valley, MD
National Provider Identifier
1346645926
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
R224646 Issued in MD
Practice address
118 Shawan Rd Ste 220
Hunt Valley, MD 21030-1318
Phone
(410) 469-4950
Fax
(410) 601-6698
NPI assigned
Oct 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R224646 MD
Primary Care Nurse Practitioner 363LP2300X R224646 MD Primary

Addresses

Primary practice location

118 Shawan Rd Ste 220
Hunt Valley, MD 21030-1318

Mailing address

3419 Edwards LN
Middle River, MD 21220-2912

Other identifiers 3

IdentifierTypeStateIssuer
R224646OtherMDMARYLAND BOARD OF NURSING
20142571OtherPEDIATRIC NURSING CERTIFICATION BOARD
251205000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240520003630 MD Practitioner - Nurse Practitioner 9234571472 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R224646MDMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Community Physicians, Inc CurrentSince May 20, 2024 Accepting new patients
Lifebridge Community Physicians, Inc Current Accepting new patients
Lifebridge Community Physicians Inc CurrentSince May 20, 2024 Accepting new patients
Shahab a Malik MD, LLC. PastSince Aug 18, 2024 Accepting new patients

Locations

118 Shawan Rd
Ste 220
Hunt Valley, MD 21030
Phone (410) 469-4950

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1346645926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 EDWARDS LN",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 SHAWAN RD STE 220",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210301318",
            "telephone_number": "410-469-4950",
            "fax_number": "410-601-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBOTKA",
        "first_name": "LAUREN",
        "middle_name": "PALANK",
        "name_prefix": "Mrs.",
        "credential": "MSN, RN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-25",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R224646",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R224646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF NURSING",
            "identifier": "R224646",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEDIATRIC NURSING CERTIFICATION BOARD",
            "identifier": "20142571",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251205000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hunt Valley, MD

Sources for this page

Verify at the official NPI Registry.