Healthcare Provider Details

I. General information

NPI: 1093987729
Provider Name (Legal Business Name): GREATER BADEN MEDICAL SERVICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 ADDISON RD S
CAPITOL HEIGHTS MD
20743-4413
US

IV. Provider business mailing address

7450 ALBERT RD FL 3
BRANDYWINE MD
20613-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-324-1500
  • Fax: 240-492-2526
Mailing address:
  • Phone: 301-888-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY A KURCAB
Title or Position: CFO
Credential:
Phone: 301-599-2172