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BALTIMORE KETAMINE CLINIC
NPI 1972145381
Nurse Practitioner - Psychiatric/Mental Health in Sparks Glencoe, MD

Active since October 17, 2019
909 RIDGEBROOK RD STE 202, SPARKS GLENCOE, MD 21152(410) 870-5482(410) 628-1212 Get Directions Write a Review

NPPES record last updated: May 15, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 15, 2025, Oct 17, 2019 (2 updates tracked since 2019).

About Baltimore Ketamine Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BALTIMORE KETAMINE CLINIC (NPI 1972145381) is a healthcare organization registered as a psychiatric/mental health in Sparks Glencoe, Maryland and active in the NPI registry since October 2019. The organization lists Ivana Mitic, Group Owner, as its authorized official.

NPPES Registry Identity

NPI1972145381
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameBALTIMORE KETAMINE CLINIC
Location Address909 RIDGEBROOK RD STE 202Sparks Glencoe, MD 21152-9476
Mailing Address1 Texas Station Ct Ste 320Timonium, MD 21093-8290 · (410) 870-5482 · Fax (410) 628-1212
Phone(410) 870-5482
Fax(410) 628-1212
Organization SubpartNo
Authorized OfficialIvana MiticGroup Owner · (713) 412-3462
Enumeration DateOctober 17, 2019
Last NPPES UpdateMay 15, 20252 updates tracked since enumeration
NPPES CertifiedMay 15, 2025
✔ NPI 1972145381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Also ListedClinic/Center · Infusion TherapyTaxonomy 261QI0500X
909 RIDGEBROOK RD STE 202, Sparks Glencoe, MD 21152
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BALTIMORE KETAMINE CLINIC
Clinic/Center (Infusion Therapy)
909 RIDGEBROOK RD STE 202
SPARKS, MD 21152
Baltimore County (410) 870-5482
IVANA MITIC CRNA
Nurse Practitioner (Psychiatric/Mental Health)
909 RIDGEBROOK RD STE 202
SPARKS, MD 21152
Baltimore County (410) 870-5482

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Baltimore Ketamine Clinic's NPI number?

The NPI number for Baltimore Ketamine Clinic is 1972145381. It was assigned to this organization in the NPPES registry on October 17, 2019.

Where is Baltimore Ketamine Clinic located?

Baltimore Ketamine Clinic is located at 909 Ridgebrook Rd Ste 202, Sparks Glencoe, MD 21152. The listed phone number is (410) 870-5482.

What is Baltimore Ketamine Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Baltimore Ketamine Clinic was last updated on May 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.