Healthcare Provider Details

I. General information

NPI: 1720383342
Provider Name (Legal Business Name): MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 DRUID PARK DR
BALTIMORE MD
21215-7800
US

IV. Provider business mailing address

1001 E FAYETTE ST
BALTIMORE MD
21202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-1666
  • Fax: 410-396-7397
Mailing address:
  • Phone: 410-545-7000
  • Fax: 410-396-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGINA GIBBS
Title or Position: RCM CREDENTIALING SPECIALIST
Credential:
Phone: 410-545-7000