Healthcare Provider Details

I. General information

NPI: 1528534062
Provider Name (Legal Business Name): MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MCCULLOH ST
BALTIMORE MD
21217-3044
US

IV. Provider business mailing address

1001 E FAYETTE ST
BALTIMORE MD
21202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-7734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYRONE ALONZO CHAPMAN
Title or Position: BILLING & REVENUE MGR.
Credential:
Phone: 410-396-8000