MEDICARE: FAMILY HEALTH CENTERS OF BALTIMORE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		MD

General Provider Information

NPI Number	:	1336326248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CENTERS OF BALTIMORE, INC.

Provider Business Mailing Address
First Line	:	631 CHERRY HILL RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-1228
Country	:	US
Telephone Number	:	410-354-2000
Fax Number	:	410-354-3674

Provider Business Practice Location Address
First Line	:	3540 S HANOVER ST
Second Line	:
City	:	BROOKLYN
State	:	MD
Zip	:	21225-1732
Country	:	US
Telephone Number	:	410-355-0343
Fax Number	:	410-355-5764

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PAULA B MCLELLAN
Credential	:
Telephone Number	:	410-354-2001

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	03/20/2014

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