Provider Demographics
NPI:1407801988
Name:BALTIMORE VA REHAB AND EXTENDED CARE CENTER
Entity Type:Organization
Organization Name:BALTIMORE VA REHAB AND EXTENDED CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:XIANGRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-605-7000
Mailing Address - Street 1:3900 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2108
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56508273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM53029OtherCDS
BS7766403OtherDEA
BS7766403OtherDEA