DR. COZUMEL SOUTHERN PRUETTE (NPI# 1295887750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295887750 |
| Entity Type | Individual |
| Full Name | DR. COZUMEL SOUTHERN PRUETTE |
| Other Name | DR. COZUMEL ALLYSON SOUTHERN |
| Credential | MD, MHS |
| Practice Address |
200 N Wolfe St Room 3055 Baltimore MD 21287-0011 |
| Mailing Address |
Po Box 64316 Baltimore MD 21264-4316 |
| Practice Telephone | 4109552467 |
| Mailing Telephone | 4109554427 |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2013-03-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | P20254 | MD | Allopathic & Osteopathic Physicians |
| Y | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
D67656 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 055174100 | 05 |
| Street Address |
200 N WOLFE ST ROOM 3055 |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21287-0011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912979196 | Carl E Stafstrom | Pediatrics | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2006-02-02 |
| 1528537305 | Oren Gordon | Student in an Organized Health Care Education/Training Program | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2018-11-21 |
| 1285155333 | Kelsey Stauff | Student in an Organized Health Care Education/Training Program | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2017-06-29 |
| 1518403245 | Donna Shatzer | Nurse Practitioner | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2017-01-19 |
| 1922461714 | Jacquelyn Manfredo | Student in an Organized Health Care Education/Training Program | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2016-03-30 |
| 1659753903 | Amanda Regina Wood | Nurse Practitioner | 200 N Wolfe St, Suite 2158, Baltimore, MD 21287-0011 | 2015-06-23 |
| 1871970301 | Mark Porter | Student in an Organized Health Care Education/Training Program | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2015-05-05 |
| 1841600087 | Francis Tintani | Student in an Organized Health Care Education/Training Program | 200 N Wolfe St, Suite 2-111, Baltimore, MD 21287-0011 | 2014-04-28 |
| 1861819039 | Brandon Michael Smith | Pediatrics | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2014-03-25 |
| 1437418670 | Tierra D. Burrell | Pediatrics | 200 N Wolfe St, Baltimore, MD 21287-0011 | 2012-05-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140503 | Thomas Dimitrios Zaikos | Student in an Organized Health Care Education/Training Program | Pathology Building Rm. 401, 600 N. Wolfe Street, Baltimore, MD 21287 | 2020-07-01 |
| 1316572175 | Sarah Branigan | Pediatrics | Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287 | 2020-03-11 |
| 1790318657 | Margaret Geraldine Keane | Internal Medicine | Sheikh Zayed Tower, 1800 Orleans St, Baltimore, MD 21287 | 2020-02-19 |
| 1699322636 | Lakeya Mcgill | Student in an Organized Health Care Education/Training Program | 600 North Wolfe St, Phipps 174, Baltimore, MD 21287 | 2019-08-23 |
| 1245882406 | Ranim Amer Ibrahim Alsaad | Student in an Organized Health Care Education/Training Program | 1800 Orleans Street - Johns Hopkins Hospital, Tower 110, Baltimore, MD 21287 | 2019-07-09 |
| 1992364004 | Anthony David Pisaniello | Student in an Organized Health Care Education/Training Program | 1800 Orleans St, Johns Hopkins Hospital, Baltimore, MD 21287 | 2019-06-12 |
| 1255990503 | Ethan Tumarkin | Student in an Organized Health Care Education/Training Program | 600 N. Wolfe St./halsted 500, Baltimore, MD 21287 | 2019-06-11 |
| 1629636386 | Kathleen Anne Malloy | Counselor | Jhh 600 N. Wolfe St., Cpp- Meyer 144, Baltimore, MD 21287 | 2019-05-29 |
| 1285298489 | Ashleigh Graham | Student in an Organized Health Care Education/Training Program | Pathology Building, Rm 401, 600 N. Wolfe Street, Baltimore, MD 21287 | 2019-04-24 |
| 1851955066 | Seena Tabibi | Student in an Organized Health Care Education/Training Program | Pathology Department Johns Hopkins University Som, Pathology Building Rm 401, 600 North Wolfe Street, Baltimore, MD 21287 | 2019-04-24 |
| Find all providers in zip 21287 | ||||
| Taxonomy Code | 2080P0210X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Nephrology |
| A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275908105 | Netanel G. Schwob, M.d.,p.a. | Pediatrics | 4000 Old Court Rd, Suite 203, Baltimore, MD 21208-2800 | 2015-12-03 |
| 1376898049 | Bakri J Alzarka | Pediatrics | 22 S Greene St # N5w40, Baltimore, MD 21201 | 2012-07-19 |
| 1164582474 | Jeffrey J Fadrowski | Pediatrics | 600 N Wolfe St, Park 335-peds, Baltimore, MD 21287-0005 | 2006-12-11 |
| 1336182286 | Barbara A Fivush | Pediatrics | 601 N Caroline St, Baltimore, MD 21287-0006 | 2006-06-14 |
| 1831131937 | Susan Mendley | Pediatrics | 22 S Greene St, N5w40, Baltimore, MD 21201-1544 | 2006-06-12 |
| 1548212947 | Alicia Mallare Neu | Pediatrics | 601 N Caroline St, Baltimore, MD 21287-0006 | 2006-05-16 |
| 1376530808 | Johns Hopkins University | Pediatrics | 600 N Wolfe St, Baltimore, MD 21287-0005 | 2005-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629114228 | Lorie Benton Smith | Pediatrics | 8901 Wisconsin Ave, Nnmc, Section of Pediatric Nephrology, Bethesda, MD 20889-0001 | 2007-01-30 |
| 1588683825 | Gregory Harron Gorman | Pediatrics | 8901 Wisconsin Ave, Building 10, Bethesda, MD 20889-0001 | 2006-07-18 |
| 1932177938 | Brent Lee Lechner | Pediatrics | 4301 Jones Bridge Rd, Bethesda, MD 20814-4712 | 2006-03-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.