Provider Demographics
NPI:1124042577
Name:BALTIMORE COLORECTAL & SURGICAL
Entity Type:Organization
Organization Name:BALTIMORE COLORECTAL & SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:APOSTOLIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-494-1191
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:SUITE 445
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-494-1191
Mailing Address - Fax:410-494-0058
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:SUITE 445
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-494-1191
Practice Address - Fax:410-494-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD151PMedicare ID - Type Unspecified