Provider Demographics
NPI:1275802555
Name:BALTIMORE COUNTY MARYLAND
Entity Type:Organization
Organization Name:BALTIMORE COUNTY MARYLAND
Other - Org Name:AS DEPT OF HEALTH - HIV CASE MANAGEMENT PROGRAM
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 1:6401 YORK RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2152
Practice Address - Country:US
Practice Address - Phone:410-887-2077
Practice Address - Fax:410-377-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare