Healthcare Provider Details

I. General information

NPI: 1114257144
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST UNIT 23
BALTIMORE MD
21204-6808
US

IV. Provider business mailing address

6701 N CHARLES ST S. CHAPMAN BLDG SUITE 102
BALTIMORE MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE BEYER
Title or Position: EVP & CFO
Credential:
Phone: 443-849-3284