Healthcare Provider Details

I. General information

NPI: 1821277856
Provider Name (Legal Business Name): BALTIMORE WASHINGTON PROFESSIONAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

PO BOX 64584
BALTIMORE MD
21264-4584
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY JO NOEL
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 410-787-4594