Healthcare Provider Details

I. General information

NPI: 1932651676
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST STE 405
BALTIMORE MD
21204-5830
US

IV. Provider business mailing address

6701 N CHARLES ST S CHAPMAN BLDG, STE 102
BALTIMORE MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2036
  • Fax:
Mailing address:
  • Phone: 443-849-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LAURIE R BEYER
Title or Position: EVP & CFO
Credential:
Phone: 443-849-2519