Healthcare Provider Details

I. General information

NPI: 1861577645
Provider Name (Legal Business Name): BALTIMORE COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 TWIN SPRINGS RD
BALTIMORE MD
21227-3526
US

IV. Provider business mailing address

4222 30TH ST
MOUNT RAINIER MD
20712-1752
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-4456
  • Fax: 410-887-4417
Mailing address:
  • Phone: 301-864-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR121844
License Number StateMD

VIII. Authorized Official

Name: MS. REGINA KIRWAN WARDWELL
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 410-887-4456