1043312036 NPI number — MARYLAND HEALTHCARE CLINICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043312036 NPI number — MARYLAND HEALTHCARE CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND HEALTHCARE CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043312036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21270-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-486-2298
Provider Business Mailing Address Fax Number:
410-358-6551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6615 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-2686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-2298
Provider Business Practice Location Address Fax Number:
410-358-6551
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALAKIRSKY
Authorized Official First Name:
ROMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
410-486-2298

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1255417986 . This is a "LIBERATI, DC, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1477621571 . This is a "PATTON, DC NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1477621571 . This is a "NPI NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4138091 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106387044 . This is a "WESTSIDE NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1073642377 . This is a "NPI NUMBER, DR. VO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1750467478 . This is a "MCGEE PT NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1144304965 . This is a "ANDERSON PT NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1356427017 . This is a "JONES, DC, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1922184522 . This is a "KILCHENSTEIN, DC, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1053497792 . This is a "BERRY, PTA, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1366528069 . This is a "DR. GRAY NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1558467019 . This is a "ABRAMSON, DC, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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