Provider Demographics
NPI:1336326248
Name:FAMILY HEALTH CENTERS OF BALTIMORE, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTERS OF BALTIMORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-354-2001
Mailing Address - Street 1:631 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1228
Mailing Address - Country:US
Mailing Address - Phone:410-354-2000
Mailing Address - Fax:410-354-3674
Practice Address - Street 1:3540 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-1732
Practice Address - Country:US
Practice Address - Phone:410-355-0343
Practice Address - Fax:410-355-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211832Medicare PIN