Healthcare Provider Details

I. General information

NPI: 1457993628
Provider Name (Legal Business Name): MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 E REDWOOD ST FL REDWWOD3
BALTIMORE MD
21202-1115
US

IV. Provider business mailing address

1001 E FAYETTE ST
BALTIMORE MD
21202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 443-984-2460
  • Fax: 410-396-8004
Mailing address:
  • Phone: 443-984-2624
  • Fax: 410-396-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: REGINA GIBBS
Title or Position: RCM CREDENTIALING SPECIALIST
Credential:
Phone: 410-396-8000