Provider Demographics
NPI:1437601069
Name:BALTIMORE LIPID CENTER
Entity Type:Organization
Organization Name:BALTIMORE LIPID CENTER
Other - Org Name:GREGORY POKRYWKA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BALTIMORE LIPID CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:POKRYWKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-337-0720
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7449
Mailing Address - Country:US
Mailing Address - Phone:410-337-0720
Mailing Address - Fax:410-337-0714
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7449
Practice Address - Country:US
Practice Address - Phone:410-337-0720
Practice Address - Fax:410-337-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB696830Medicare UPIN