Healthcare Provider Details

I. General information

NPI: 1841374857
Provider Name (Legal Business Name): ROLAND PARK PLACE HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W 40TH ST
BALTIMORE MD
21211-2116
US

IV. Provider business mailing address

830 W 40TH ST
BALTIMORE MD
21211-2116
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-5800
  • Fax: 410-243-4763
Mailing address:
  • Phone: 410-243-5800
  • Fax: 410-243-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number30090
License Number StateMD

VIII. Authorized Official

Name: KEITH SPILLANE
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-243-6815