Provider Demographics
NPI:1972846830
Name:GREATER BALTIMORE MEDICAL CENTER
Entity Type:Organization
Organization Name:GREATER BALTIMORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-849-2682
Mailing Address - Street 1:6565 N CHARLES ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5805
Mailing Address - Country:US
Mailing Address - Phone:443-849-3760
Mailing Address - Fax:443-849-8138
Practice Address - Street 1:6565 N CHARLES ST STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5805
Practice Address - Country:US
Practice Address - Phone:443-849-3760
Practice Address - Fax:443-849-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN/AMedicaid
MDN/AMedicaid
N/AMedicare UPIN