Healthcare Provider Details

I. General information

NPI: 1972523108
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST SUB ACUTE UNIT 54
BALTIMORE MD
21204-6808
US

IV. Provider business mailing address

PO BOX 418953
BOSTON MA
02241-8953
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2012
  • Fax: 443-849-8056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number03-072
License Number StateMD

VIII. Authorized Official

Name: LAURIE BEYER
Title or Position: EXECUTIVE VICE PRES & CFO
Credential:
Phone: 443-849-2519