Healthcare Provider Details

I. General information

NPI: 1922258367
Provider Name (Legal Business Name): GREATER BADEN MEDICAL SERVICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23140 MOAKLEY ST STE 4
LEONARDTOWN MD
20650-2923
US

IV. Provider business mailing address

7450 ALBERT RD FL 3
BRANDYWINE MD
20613-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-1029
  • Fax: 301-997-1489
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