MEDICARE: ACTIVE DAY MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1235274333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE DAY MD, INC.

Provider Business Mailing Address
First Line	:	400 REDLAND CT
Second Line	:	SUITE 114
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3270
Country	:	US
Telephone Number	:	443-548-2200
Fax Number	:	443-548-2260

Provider Business Practice Location Address
First Line	:	1001 W PRATT ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2662
Country	:	US
Telephone Number	:	410-752-8787
Fax Number	:	410-752-8797

Authorized Official
Title or Position	:	CHAIRMAN, CEO, PRESIDENT
Name	:	KRIS W. BALDOCK
Credential	:
Telephone Number	:	443-548-2201

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/09/2007

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Directions to “ACTIVE DAY MD, INC. ” Practice Location

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