Healthcare Provider Details

I. General information

NPI: 1174788137
Provider Name (Legal Business Name): FAMILY & CHILDREN'S SERVICES OF CENTRAL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1980
  • Fax: 410-366-8530
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STANLEY LEVI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-366-1980