Provider Demographics
NPI:1114665551
Name:GREATER BALTIMORE MEDICAL CENTER
Entity Type:Organization
Organization Name:GREATER BALTIMORE MEDICAL CENTER
Other - Org Name:GBMC OPTICAL CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:EVP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-849-2519
Mailing Address - Street 1:8625 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2321
Mailing Address - Country:US
Mailing Address - Phone:443-828-5558
Mailing Address - Fax:443-828-6315
Practice Address - Street 1:8625 PLEASANT PLAINS RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2321
Practice Address - Country:US
Practice Address - Phone:443-828-5558
Practice Address - Fax:443-828-6315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BALTIMORE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD445036100Medicaid