Provider Demographics
NPI:1518334978
Name:BALTIMORE COUNTY MARYLAND
Entity Type:Organization
Organization Name:BALTIMORE COUNTY MARYLAND
Other - Org Name:DEPT OF HEALTH-PARKVILLE HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WM
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-887-2702
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 1:2600 PUTTY HILL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4309
Practice Address - Country:US
Practice Address - Phone:410-887-5448
Practice Address - Fax:410-668-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare