Healthcare Provider Details

I. General information

NPI: 1558783548
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 S CATON AVE SUITE 203
BALTIMORE MD
21227-1025
US

IV. Provider business mailing address

1421 S CATON AVE SUITE 203
BALTIMORE MD
21227-1025
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-1370
  • Fax:
Mailing address:
  • Phone: 410-368-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberH0061347
License Number StateMD

VIII. Authorized Official

Name: MS. KATE GARNET
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 410-332-9808