Provider Demographics
NPI:1215207394
Name:BALTIMORE COUNTY MARYLAND
Entity Type:Organization
Organization Name:BALTIMORE COUNTY MARYLAND
Other - Org Name:DETP OF HEALTH - LANSDOWNE MIDDLE SCHOOL WELLNESS CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-887-2077
Mailing Address - Street 1:6401 YORK RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2152
Mailing Address - Country:US
Mailing Address - Phone:410-887-2077
Mailing Address - Fax:410-377-9646
Practice Address - Street 1:2400 LANSDOWNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2019
Practice Address - Country:US
Practice Address - Phone:410-887-4130
Practice Address - Fax:410-377-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420947800Medicaid