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	License Number	License Number State
1	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1487191375
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	:	410-396-9410
Fax Number	:	410-396-7897

Provider Business Practice Location Address
First Line	:	908 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-2318
Country	:	US
Telephone Number	:	410-396-0176
Fax Number	:

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

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	05/26/2026

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

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