Active NPI
Andrea Pellom
- Dental Hygienist
- Baltimore, MD
National Provider Identifier
1942670799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 7148
- Practice address
- 3319 W Belvedere Ave
Baltimore, MD 21215-5143 - Phone
- (410) 542-7800
- Fax
- (410) 542-2039
- NPI assigned
- Oct 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 7148 | MD | Primary |
Addresses
Primary practice location
3319 W Belvedere Ave
Baltimore, MD 21215-5143
Mailing address
6005 Belle Grove Rd
Baltimore, MD 21225-3261
Phone (410) 919-8278
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7148 | MD | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1942670799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6005 BELLE GROVE RD",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212253261",
"telephone_number": "410-919-8278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3319 W BELVEDERE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212155143",
"telephone_number": "410-542-7800",
"fax_number": "410-542-2039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLOM",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-05",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MD",
"license": "7148",
"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 Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.