Healthcare Provider Details

I. General information

NPI: 1669738357
Provider Name (Legal Business Name): BALTIMORE CHILD ABUSE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHARLES ST SUITE 400
BALTIMORE MD
21218-5137
US

IV. Provider business mailing address

2300 N CHARLES ST SUITE 400
BALTIMORE MD
21218-5137
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-6147
  • Fax:
Mailing address:
  • Phone: 410-396-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0039907
License Number StateMD

VIII. Authorized Official

Name: MRS. LADONNA MORGAN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 410-396-6147