Healthcare Provider Details

I. General information

NPI: 1003068784
Provider Name (Legal Business Name): MARYLAND HEALTHCARE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8113 HARFORD RD SUITE 200
BALTIMORE MD
21234-5790
US

IV. Provider business mailing address

8113 HARFORD RD SUITE 200
BALTIMORE MD
21234-5790
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-5882
  • Fax: 410-882-2933
Mailing address:
  • Phone: 410-882-5882
  • Fax: 410-882-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMAN BALAKIRSKY
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-318-6253