Provider Demographics
NPI:1891262135
Name:EMERGE BALTIMORE INC.
Entity Type:Organization
Organization Name:EMERGE BALTIMORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:443-414-3704
Mailing Address - Street 1:1803 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3235
Mailing Address - Country:US
Mailing Address - Phone:443-366-6335
Mailing Address - Fax:855-539-9696
Practice Address - Street 1:1803 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3235
Practice Address - Country:US
Practice Address - Phone:443-366-6335
Practice Address - Fax:855-539-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center