Provider Demographics
| NPI: | 1124016696 |
|---|---|
| Name: | BALTIMORE WASHINGTON MEDICAL CENTER INC. |
| Entity Type: | Organization |
| Organization Name: | BALTIMORE WASHINGTON MEDICAL CENTER INC. |
| Other - Org Name: | UNIVERSITY OF MARYLAND BALTIMORE WASHINGTON MEDICAL CENTER |
| Other - Org Type: | Other Name |
| Authorized Official - Title/Position: | MANAGED CARE COORDINATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHERRY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HILLIARD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 410-787-4897 |
| Mailing Address - Street 1: | 301 HOSPITAL DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GLEN BURNIE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21061-5803 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 410-787-4000 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 301 HOSPITAL DR |
| Practice Address - Street 2: | |
| Practice Address - City: | GLEN BURNIE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21061-5803 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 410-787-4000 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-10-10 |
| Last Update Date: | 2013-09-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 000445600 | Medicaid | |
| 234175 | Other | MAMSI | |
| 45749 | Other | AMERIGROUP | |
| 52095 | Other | KAISER PERMANENTE | |
| 0062413 | Other | MAIL HANDLERS | |
| 396674 | Other | FEDERAL BLACK LUNG | |
| DE | 0000413405 | Medicaid | |
| 5000081 | Other | UHC | |
| 57359101 | Other | BLUE CROSS BLUE SHIELD | |
| VA | 0175542000 | Medicaid | |
| 23222 | Other | AETNA US HEALTHCARE | |
| 07539 | Other | AETNA | |
| 145243800 | Other | DEPT.OF LABOR | |
| 73288 | Other | HUMANA | |
| HE4 | Other | BLUE CROSS BLUE SHIELD | |
| 234175 | Other | MAMSI | |
| 396674 | Other | FEDERAL BLACK LUNG | |
| MD | CG7577 | Medicare PIN | |
| 57359101 | Other | BLUE CROSS BLUE SHIELD | |
| MD | 000445600 | Medicaid |
