Provider Demographics
NPI:1720383342
Name:MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type:Organization
Organization Name:MAYOR AND CITY COUNCIL OF BALTIMORE
Other - Org Name:BALTIMORE INFANTS AND TODDLERS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING & REVENUE CYCLE MGR
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-739-3253
Mailing Address - Street 1:1001 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4715
Mailing Address - Country:US
Mailing Address - Phone:410-396-1666
Mailing Address - Fax:410-396-7397
Practice Address - Street 1:3002 DRUID PARK DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7800
Practice Address - Country:US
Practice Address - Phone:410-396-1666
Practice Address - Fax:410-396-7397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAYOR AND CITY COUNCIL OF BALTIMORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD166301100Medicaid