Provider Demographics
NPI:1598762064
Name:BALTIMORE ULTRASOUND SERVICES,INC
Entity Type:Organization
Organization Name:BALTIMORE ULTRASOUND SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-529-6666
Mailing Address - Street 1:3814 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2203
Mailing Address - Country:US
Mailing Address - Phone:410-529-6666
Mailing Address - Fax:410-529-0019
Practice Address - Street 1:3814 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2203
Practice Address - Country:US
Practice Address - Phone:410-529-6666
Practice Address - Fax:410-529-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMA008Medicare ID - Type Unspecified