Provider Demographics
NPI:1619494242
Name:BALTIMORE ADULT MEDICAL DAY CARE
Entity Type:Organization
Organization Name:BALTIMORE ADULT MEDICAL DAY CARE
Other - Org Name:BALTIMORE ADULT MEDICAL DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DIWASH
Authorized Official - Middle Name:
Authorized Official - Last Name:POKHAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-935-3808
Mailing Address - Street 1:1109 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4735
Mailing Address - Country:US
Mailing Address - Phone:432-935-3808
Mailing Address - Fax:
Practice Address - Street 1:1109 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4735
Practice Address - Country:US
Practice Address - Phone:432-935-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid