1043312036 NPI number — MARYLAND HEALTHCARE CLINICS

Table of content: (NPI 1043312036)

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

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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