Provider Demographics
NPI:1457993628
Name:MAYOR AND CITY COUNCIL OF BALTIMORE
Entity Type:Organization
Organization Name:MAYOR AND CITY COUNCIL OF BALTIMORE
Other - Org Name:LEAD POISONING PREVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING & REVENUE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-739-3253
Mailing Address - Street 1:1001 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4715
Mailing Address - Country:US
Mailing Address - Phone:443-984-2624
Mailing Address - Fax:410-396-8009
Practice Address - Street 1:7 E REDWOOD ST FL REDWWOD3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1115
Practice Address - Country:US
Practice Address - Phone:443-984-2460
Practice Address - Fax:410-396-8004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAYOR AND CITY COUNCIL OF BALTIMORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-09
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420845500Medicaid