Healthcare Provider Details

I. General information

NPI: 1497921373
Provider Name (Legal Business Name): MARYLAND TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FREDERICK AVE
BALTIMORE MD
21229-3618
US

IV. Provider business mailing address

3800 FREDERICK AVE
BALTIMORE MD
21229-3618
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-1400
  • Fax: 410-233-1666
Mailing address:
  • Phone: 410-233-1400
  • Fax: 410-233-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0038913
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. MARC J. FISHMAN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 410-233-1400