Provider Demographics
NPI:1942373964
Name:GREATER BALTIMORE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:GREATER BALTIMORE MEDICAL CENTER, INC.
Other - Org Name:GBMC, INC.-INFECTIOUS DISEASE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRES & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-849-2519
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:STE 306
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-581-7804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BALTIMORE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ68MEOtherCAREFIRST MARYLAND
MDS121OtherCAREFIRST REGIONAL
MD512501402Medicaid
MD716LMedicare PIN