Healthcare Provider Details

I. General information

NPI: 1043312036
Provider Name (Legal Business Name): MARYLAND HEALTHCARE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD FIRST FLOOR
BALTIMORE MD
21215-2686
US

IV. Provider business mailing address

PO BOX 30160
BALTIMORE MD
21270-0160
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2298
  • Fax: 410-358-6551
Mailing address:
  • Phone: 410-486-2298
  • Fax: 410-358-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMAN BALAKIRSKY
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 410-486-2298