Provider Demographics
NPI:1043312036
Name:MARYLAND HEALTHCARE CLINICS
Entity Type:Organization
Organization Name:MARYLAND HEALTHCARE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
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:410-486-2298
Mailing Address - Street 1:PO BOX 30160
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21270-0160
Mailing Address - Country:US
Mailing Address - Phone:410-486-2298
Mailing Address - Fax:410-358-6551
Practice Address - Street 1:6615 REISTERSTOWN RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2686
Practice Address - Country:US
Practice Address - Phone:410-486-2298
Practice Address - Fax:410-358-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1255417986OtherLIBERATI, DC, NPI
MD1477621571OtherPATTON, DC NPI
MD1477621571OtherNPI NUMBER
MD4138091 00Medicaid
106387044OtherWESTSIDE NPI NUMBER
MD1073642377OtherNPI NUMBER, DR. VO
MD1750467478OtherMCGEE PT NPI
MD1144304965OtherANDERSON PT NPI
MD1356427017OtherJONES, DC, NPI
MD1922184522OtherKILCHENSTEIN, DC, NPI
MD1053497792OtherBERRY, PTA, NPI
MD1366528069OtherDR. GRAY NPI
MD1558467019OtherABRAMSON, DC, NPI
MD4138091 00Medicaid
MD729LR734Medicare PIN
MD729LR735Medicare PIN