Healthcare Provider Details

I. General information

NPI: 1679628846
Provider Name (Legal Business Name): MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W NORTH AVE
BALTIMORE MD
21217-1735
US

IV. Provider business mailing address

1001 E FAYETTE ST
BALTIMORE MD
21202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-4501
  • Fax: 410-962-8726
Mailing address:
  • Phone: 443-984-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number30000559
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYRONE ALONZO CHAPMAN
Title or Position: BILLING & REVENUE MGR.
Credential:
Phone: 443-739-3253