1548266547 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 1548266547 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:
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:
1548266547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2023
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:
410-732-8800
Provider Business Mailing Address Fax Number:
410-327-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 FLEET ST STE 200
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:
21224-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-4888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
410-558-4891

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 376751500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".