Provider Demographics
NPI:1700036183
Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Entity Type:Organization
Organization Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Other - Org Name:GREATER BADEN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-658-7226
Mailing Address - Street 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:301-599-0460
Mailing Address - Fax:301-599-0463
Practice Address - Street 1:7450 ALBERT RD FL 3
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3035
Practice Address - Country:US
Practice Address - Phone:301-599-0460
Practice Address - Fax:301-888-9133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BADEN MEDICAL SERVICE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD911431900Medicaid
MD211817Medicare PIN