Provider Demographics
NPI:1972523108
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:
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUB ACUTE UNIT 54
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2012
Practice Address - Fax:443-849-8056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BALTIMORE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-072273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD584615-02OtherCAREFIRST OF MARYLAND
MD745210100Medicaid
MDRL1/0001OtherCAREFIRST REGIONAL
MD215314Medicare Oscar/Certification
MD215314Medicare PIN