Healthcare Provider Details

I. General information

NPI: 1356226500
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 512
BALTIMORE MD
21204-6826
US

IV. Provider business mailing address

6545 N CHARLES ST STE 102
BALTIMORE MD
21204-6836
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax: 443-849-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA CAMPBELL
Title or Position: INTERIM EVP & CFO
Credential:
Phone: 443-849-3844