MEDICARE: BALTIMORE COUNTY MARYLAND

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	261QS1000X	Student Health Clinic/Center

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	:	1679843759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTIMORE COUNTY MARYLAND

Provider Business Mailing Address
First Line	:	6401 YORK RD
Second Line	:	3RD FLOOR
City	:	BALTIMORE
State	:	MD
Zip	:	21212-2152
Country	:	US
Telephone Number	:	410-887-2077
Fax Number	:	410-377-9646

Provider Business Practice Location Address
First Line	:	142 BENNETT RD
Second Line	:
City	:	ESSEX
State	:	MD
Zip	:	21221-1316
Country	:	US
Telephone Number	:	410-887-4130
Fax Number	:	410-377-9646

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	MR. DAVID C TAYLOR
Credential	:
Telephone Number	:	410-887-2077

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	04/22/2014

Similar Medicare Providers

1942346010 — BALTIMORE COUNTY DEPARTMENT OF HEALTH
Practice Location Address:

142 BENNETT RD
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1356803654 — KATE LEE SMITH MS, OTR/L, CPAM
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1730255746 — MR. CHARLES A LOPEZ L.P.C.
Practice Location Address:

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1952479990 — DR. CHERYL SUSAN FUTTERMAN PH.D.
Practice Location Address:

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1285858183 — MRS. JOAN O'LEARY LCSW
Practice Location Address:

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Directions to “BALTIMORE COUNTY MARYLAND ” Practice Location

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