Provider Demographics
NPI:1568624856
Name:GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:GREATER BALTIMORE MEDICAL CENTER, INC.
Other - Org Name:GBMC INC./SPEECH PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MELCHIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-849-2519
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:STE 250
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:443-849-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BALTIMORE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-27
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415132100Medicaid
MDS129OtherCAREFIRST REGIONAL
MDKJ47OtherCAREFIRST MARYLAND
MDKJ47OtherCAREFIRST MARYLAND