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General NPI Number Information
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NPI Number | 1851748297
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Entity Type | Organization
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Legal Business Name | BALTIMORE RAVENS
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1 WINNING DR
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4776
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Country | US
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Telephone | 410-259-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 OWINGS PARK DR APARTMENT K
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3586
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Country | US
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Telephone | 908-770-7182
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Fax |
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Authorized Official
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Title or Position | HEAD ATHLETIC TRAINER
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Name | MARK SMITH
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Credential |
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Telephone | 410-259-8548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | A0000845
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License Number State | MD
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