Provider Demographics
NPI: | 1275578106 |
---|---|
Name: | GREATER BALTIMORE MEDICAL CENTER, INC. |
Entity type: | Organization |
Organization Name: | GREATER BALTIMORE MEDICAL CENTER, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE VICE PRES & CFO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LAURIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BEYER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-849-2519 |
Mailing Address - Street 1: | 6701 N CHARLES ST |
Mailing Address - Street 2: | SOUTH CHAPMAN BLDG, STE 102 |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21204-6808 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-849-2435 |
Mailing Address - Fax: | 443-849-3138 |
Practice Address - Street 1: | 6701 N CHARLES ST |
Practice Address - Street 2: | DEPT OF MEDICINE |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21204-6808 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-849-2000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-17 |
Last Update Date: | 2025-04-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LC0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 512501400 | Medicaid | |
MD | S138 | Other | CAREFIRST REGIONAL |
MD | KJ72 | Other | CAREFIRST MARYLAND |
MD | S851 | Other | CAREFIRST REGIONAL |
MD | 4959 | Other | CF BLUECHOICE LYMPHEDEMA |
MD | CC0899 | Medicare PIN | |
MD | KJ72 | Other | CAREFIRST MARYLAND |
MD | 700L | Medicare PIN | |
MD | 4959 | Other | CF BLUECHOICE LYMPHEDEMA |
MD | S851 | Other | CAREFIRST REGIONAL |