MEDICARE: MAYOR AND CITY COUNCIL OF BALTIMORE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1467231928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYOR AND CITY COUNCIL OF BALTIMORE

Provider Business Mailing Address
First Line	:	1001 E FAYETTE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4715
Country	:	US
Telephone Number	:	410-396-8000
Fax Number	:	410-396-4008

Provider Business Practice Location Address
First Line	:	1200 E FAYETTE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4721
Country	:	US
Telephone Number	:	410-396-4501
Fax Number	:	410-396-5525

Authorized Official
Title or Position	:	RCM CREDENTIALING SPECIALIST
Name	:	REGINA GIBBS
Credential	:
Telephone Number	:	410-396-8000

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	05/26/2026

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Directions to “MAYOR AND CITY COUNCIL OF BALTIMORE ” Practice Location

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