1811993611 NPI number — BALTIMORE MEDICAL SYSTEM INC

Table of content: (NPI 1811993611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811993611 NPI number — BALTIMORE MEDICAL SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALTIMORE MEDICAL SYSTEM INC
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:
1811993611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/13/2023
NPI Reactivation Date:
06/20/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 EASTERN AVE STE 301
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:
21224-2796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-732-8800
Provider Business Mailing Address Fax Number:
410-327-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CATON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-703-3200
Provider Business Practice Location Address Fax Number:
443-703-3201
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
410-558-4891

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 376751500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 376751513 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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