Provider Demographics
NPI:1124172630
Name:BALTIMORE CLINICAL GROUP
Entity type:Organization
Organization Name:BALTIMORE CLINICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR & PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW C MSW
Authorized Official - Phone:410-653-9356
Mailing Address - Street 1:3635 OLD COURT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-653-9356
Mailing Address - Fax:410-321-9371
Practice Address - Street 1:3635 OLD COURT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-9356
Practice Address - Fax:410-321-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R09848Medicare UPIN