Provider Demographics
NPI:1710071725
Name:BALTIMORE WASHINGTON PROFESSIONAL SERVICES INC.
Entity Type:Organization
Organization Name:BALTIMORE WASHINGTON PROFESSIONAL SERVICES INC.
Other - Org Name:THE AIELLO BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-553-8353
Mailing Address - Street 1:203 HOSPITAL DR
Mailing Address - Street 2:SUITE B100
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6904
Mailing Address - Country:US
Mailing Address - Phone:410-553-8351
Mailing Address - Fax:410-553-8352
Practice Address - Street 1:203 HOSPITAL DR
Practice Address - Street 2:SUITE B100
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6904
Practice Address - Country:US
Practice Address - Phone:410-553-8351
Practice Address - Fax:410-553-8352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE WASHINGTON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1622878OtherUNITED HEALTHCARE PROVIDE
MD2131125OtherMAMSI PROVIDER NUMBER
MD3767375OtherAETNA HMO PROVIDER NUMBER
MD406923400Medicaid
MD33525OtherJOHN HOPKINS HEALTH CARE
MD1303080OtherCIGNA PROVIDER NUMBER
MD704197OtherNCPPO PROVIDER NUMBER
MDDD8312OtherMEDICARE RAILROAD
MHJ6860006OtherCAREFIRST BCBS OF DC PROV
MH5353197OtherAETNA PPO PROVIDER NUMBER
MD645177-01OtherCAREFIRST BCBS OF MD PROV
MD9002247OtherPRIVATE HEALTHCARE SYSTEM
MD704197OtherNCPPO PROVIDER NUMBER
MD704197OtherNCPPO PROVIDER NUMBER
MD165725ZEZJMedicare PIN