Healthcare Provider Details

I. General information

NPI: 1578832374
Provider Name (Legal Business Name): BALTIMORE COUNTY MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 ANNAPOLIS RD
HALETHORPE MD
21227-2249
US

IV. Provider business mailing address

6401 YORK RD 3RD FLOOR
BALTIMORE MD
21212-2152
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-1003
  • Fax: 410-377-9646
Mailing address:
  • Phone: 410-887-2077
  • Fax: 410-377-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONIA ROSS
Title or Position: BILLING MNANAGER
Credential:
Phone: 410-887-0684