MEDICARE: PEOPLE'S COMMUNITY HEALTH CENTER -DENTAL

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	261QC1500X	Community Health Clinic/Center		MD

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	:	1609942515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLE'S COMMUNITY HEALTH CENTER -DENTAL

Provider Business Mailing Address
First Line	:	2524 KIRK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4826
Country	:	US
Telephone Number	:	410-467-6040
Fax Number	:	410-735-5897

Provider Business Practice Location Address
First Line	:	3011 GREENMOUNT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-3939
Country	:	US
Telephone Number	:	410-467-6040
Fax Number	:	410-735-5897

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PATRICIA S CASSATT SR.
Credential	:	MS
Telephone Number	:	410-467-6040

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	05/16/2008

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