Healthcare Provider Details

I. General information

NPI: 1528880804
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST STE 1630
BALTIMORE MD
21204-6808
US

IV. Provider business mailing address

6701 N. CHARLES STREET S. CHAPMAN BUILDING, SUITE 102
BALTIMORE MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-4145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA CAMPBELL
Title or Position: INTERIM EVP/CFO
Credential:
Phone: 443-849-3844