Healthcare Provider Details

I. General information

NPI: 1518119205
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

3301 BELAIR RD
BALTIMORE MD
21213-1202
US

IV. Provider business mailing address

3301 BELAIR RD
BALTIMORE MD
21213-1202
US

V. Phone/Fax

Practice location:
  • Phone: 410-792-6110
  • Fax: 410-732-6112
Mailing address:
  • Phone: 410-792-6110
  • Fax: 410-732-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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