Healthcare Provider Details

I. General information

NPI: 1720139512
Provider Name (Legal Business Name): BALTIMORE EYE SURGICAL CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 N CHARLES ST
BALTIMORE MD
21212-1113
US

IV. Provider business mailing address

6231 N CHARLES ST
BALTIMORE MD
21212-1113
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-5821
  • Fax: 410-377-8061
Mailing address:
  • Phone: 410-377-2044
  • Fax: 410-377-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PASCETTA
Title or Position: CFO
Credential:
Phone: 860-652-5002