Healthcare Provider Details

I. General information

NPI: 1811225360
Provider Name (Legal Business Name): BALTIMORE WASHINGTON MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR SECOND FLOOR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

PO BOX 62486
BALTIMORE MD
21264-2486
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: REBECCA LYNN PAESCH
Title or Position: DIRECTOR
Credential:
Phone: 410-787-4879