Healthcare Provider Details

I. General information

NPI: 1811079403
Provider Name (Legal Business Name): MARYLAND GENERAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE
BALTIMORE MD
21201-4606
US

IV. Provider business mailing address

827 LINDEN AVE
BALTIMORE MD
21201-4606
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN BAILEY
Title or Position: CFO
Credential:
Phone: 410-225-8446