Healthcare Provider Details

I. General information

NPI: 1952124760
Provider Name (Legal Business Name): GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LASALLE ROAD SUITE 100, POTOMAC BUILDING
TOWSON MD
21286
US

IV. Provider business mailing address

6701 N. CHARLES STREET S. CHAPMAN BUILDING, SUITE 102
BALTIMORE MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 443-921-4683
  • Fax:
Mailing address:
  • Phone: 443-849-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE R BEYER
Title or Position: EVP & CFO
Credential:
Phone: 443-849-2519