MEDICARE: MARYLAND GENERAL CLINICAL PRACTICE GROUP, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1265289599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND GENERAL CLINICAL PRACTICE GROUP, INC.

Provider Business Mailing Address
First Line	:	900 ELKRIDGE LANDING RD FL 2
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 S PACA ST STE 113TH
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1735
Country	:	US
Telephone Number	:	410-328-3117
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	GEORGE SPRINKEL
Credential	:
Telephone Number	:	410-328-1501

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/03/2024

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