MEDICARE: MAYOR AND CITY COUNCIL OF BALTIMORE

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	251K00000X	Public Health or Welfare Agency	30000559	MD
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679628846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYOR AND CITY COUNCIL OF BALTIMORE

Provider Business Mailing Address
First Line	:	1001 E FAYETTE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4715
Country	:	US
Telephone Number	:	443-984-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1735
Country	:	US
Telephone Number	:	410-396-4501
Fax Number	:	410-962-8726

Authorized Official
Title or Position	:	BILLING & REVENUE MGR.
Name	:	TYRONE ALONZO CHAPMAN
Credential	:
Telephone Number	:	443-739-3253

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	10/03/2023

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