Healthcare Provider Details

I. General information

NPI: 1407801988
Provider Name (Legal Business Name): BALTIMORE VA REHAB AND EXTENDED CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

IV. Provider business mailing address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 410-605-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberD56508
License Number StateMD

VIII. Authorized Official

Name: XIANGRONG SHAO
Title or Position: ATTENDING PHYSICIAN
Credential: M.D.
Phone: 410-605-7000