Provider Demographics
NPI:1003068784
Name:MARYLAND HEALTHCARE CLINICS
Entity Type:Organization
Organization Name:MARYLAND HEALTHCARE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAKIRSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-318-6253
Mailing Address - Street 1:8113 HARFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5790
Mailing Address - Country:US
Mailing Address - Phone:410-882-5882
Mailing Address - Fax:410-882-2933
Practice Address - Street 1:8113 HARFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5790
Practice Address - Country:US
Practice Address - Phone:410-882-5882
Practice Address - Fax:410-882-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND HEALTHCARE CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD729LMedicare PIN