Provider Demographics
NPI:1114593977
Name:BALTIMORE COUNTY MARYLAND
Entity Type:Organization
Organization Name:BALTIMORE COUNTY MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT CLERK 2
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-853-8989
Mailing Address - Street 1:6401 YORK ROAD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:410-853-8989
Mailing Address - Fax:410-832-8549
Practice Address - Street 1:3525 RESOURCE DR
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4733
Practice Address - Country:US
Practice Address - Phone:410-887-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE COUNTY MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech