Provider Demographics
NPI:1356465983
Name:BALTIMORE LASER SOLUTIONS
Entity type:Organization
Organization Name:BALTIMORE LASER SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FADLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-252-2391
Mailing Address - Street 1:9608 DEERECO ROAD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-252-2391
Mailing Address - Fax:
Practice Address - Street 1:9608 DEERECO ROAD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2120
Practice Address - Country:US
Practice Address - Phone:410-252-2391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty