Healthcare Provider Details

I. General information

NPI: 1790738359
Provider Name (Legal Business Name): ENDOCENTRE OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD SUITE 180
BALTIMORE MD
21208-6391
US

IV. Provider business mailing address

1838 GREENE TREE RD SUITE 400
BALTIMORE MD
21208-6391
US

V. Phone/Fax

Practice location:
  • Phone: 410-602-7782
  • Fax: 410-602-2438
Mailing address:
  • Phone: 410-602-7782
  • Fax: 410-602-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD WOLF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-602-7782