Provider Demographics
NPI:1063687044
Name:MARYLAND HEALTHCARE CLINICS
Entity Type:Organization
Organization Name:MARYLAND HEALTHCARE CLINICS
Other - Org Name:MARYLAND HEALTHCARE CLINICS
Other - Org Type:Other Name
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:410-358-3200
Mailing Address - Street 1:6615 REISTERSTOWN RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2686
Mailing Address - Country:US
Mailing Address - Phone:410-318-6253
Mailing Address - Fax:410-358-0093
Practice Address - Street 1:2459 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2856
Practice Address - Country:US
Practice Address - Phone:410-945-6018
Practice Address - Fax:410-945-4076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND HEALTHCARE CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
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