MEDICARE: GREATER BADEN MEDICAL SERVICE INCORPORATED

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	174H00000X	Health Educator
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275783615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER BADEN MEDICAL SERVICE INCORPORATED

Provider Business Mailing Address
First Line	:	7450 ALBERT RD FL 3
Second Line	:
City	:	BRANDYWINE
State	:	MD
Zip	:	20613-3035
Country	:	US
Telephone Number	:	301-888-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 ADDISON RD S
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4413
Country	:	US
Telephone Number	:	301-324-1500
Fax Number	:	301-324-6405

Authorized Official
Title or Position	:	CFO
Name	:	JEFFREY A KURCAB
Credential	:
Telephone Number	:	301-599-2172

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	02/29/2024

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