Provider Demographics
NPI:1043418494
Name:PACIFIC REHAB OF MARYLAND
Entity Type:Organization
Organization Name:PACIFIC REHAB OF MARYLAND
Other - Org Name:ST PAUL AND BIDDLE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-908-0946
Mailing Address - Street 1:1120 ST PAUL ST B
Mailing Address - Street 2:GROUND LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-685-7790
Mailing Address - Fax:410-332-9988
Practice Address - Street 1:1120 ST PAUL ST
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-685-7790
Practice Address - Fax:410-332-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty