Provider Demographics
NPI:1770684805
Name:MARYLAND GENERAL CLINICAL PRACTICE GROUP, INC.
Entity Type:Organization
Organization Name:MARYLAND GENERAL CLINICAL PRACTICE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-1501
Mailing Address - Street 1:PO BOX 64522
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4522
Mailing Address - Country:US
Mailing Address - Phone:443-462-5093
Mailing Address - Fax:
Practice Address - Street 1:827 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21264-0001
Practice Address - Country:US
Practice Address - Phone:443-462-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK106Medicare PIN
MDS966Medicare PIN
MDK107Medicare PIN
MDKL74Medicare PIN