1447945290 NPI number — BALTIMORE MEDICAL SYSTEM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447945290 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:
BALTIMORE MEDICAL SYSTEM, INC.
Provider Other Organization Name Type Code:
3
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:
1447945290
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:
06/01/2023

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:
443-703-3654
Provider Business Mailing Address Fax Number:
443-703-3238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 EASTERN AVE STE 104
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:
21224-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-4990
Provider Business Practice Location Address Fax Number:
443-934-2257
Provider Enumeration Date:
04/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY OPERATIONS
Authorized Official Telephone Number:
443-703-3654

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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