Healthcare Provider Details

I. General information

NPI: 1356279194
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 N CHARLES ST STE 702
BALTIMORE MD
21204-6832
US

IV. Provider business mailing address

6701 N CHARLES ST. SOUTH CHAPMAN BUILDING, SUITE 102
BALTIMORE MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-4270
  • Fax:
Mailing address:
  • Phone: 443-849-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER CARL OSTASEWSKI
Title or Position: CFO
Credential:
Phone: 717-531-1159