Healthcare Provider Details

I. General information

NPI: 1730388711
Provider Name (Legal Business Name): BALTIMORE WASHINGTON GASTROENTEROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY SUITE 305A
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

PO BOX 8198
ELKRIDGE MD
21075-8198
US

V. Phone/Fax

Practice location:
  • Phone: 410-435-3023
  • Fax: 410-435-3025
Mailing address:
  • Phone: 410-435-3023
  • Fax: 410-435-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GREINER
Title or Position: BILLING
Credential:
Phone: 866-905-6436