Healthcare Provider Details

I. General information

NPI: 1063234136
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 N CHARLES ST STE 307
BALTIMORE MD
21204-5816
US

IV. Provider business mailing address

6701 N. CHARLES ST S. CHAPMAN BUILDING STE 102
BALTIMORE MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSHUA CAMPBELL
Title or Position: INTERIM EVP/CFO
Credential:
Phone: 443-849-3844