Active NPI
Ethan Soudry, M.D.
- Otolaryngology Physician
- Baltimore, MD
National Provider Identifier
1912206889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 127459
- Practice address
- 2416 Forest Green CT
Baltimore, MD 21209-1566 - Phone
- (443) 352-8992
- NPI assigned
- Mar 17, 2011
- Last updated
- Mar 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 127459 | ZZ | Primary |
Addresses
Primary practice location
2416 Forest Green CT
Baltimore, MD 21209-1566
Mailing address
2416 Forest Green CT
Baltimore, MD 21209-1566
Phone (443) 352-8992
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127459 | ZZ | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300320000000",
"number": "1912206889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2416 FOREST GREEN CT",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212091566",
"telephone_number": "443-352-8992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2416 FOREST GREEN CT",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212091566",
"telephone_number": "443-352-8992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUDRY",
"first_name": "ETHAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-17",
"last_updated": "2011-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "ZZ",
"license": "127459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.