Provider Demographics
NPI:1700882503
Name:BALTIMORE MEDICAL SYSTEM, INC.
Entity Type:Organization
Organization Name:BALTIMORE MEDICAL SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-558-4891
Mailing Address - Street 1:5525 EASTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2796
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-327-1693
Practice Address - Street 1:5525 EASTERN AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2796
Practice Address - Country:US
Practice Address - Phone:410-732-8800
Practice Address - Fax:410-327-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-06-27
Deactivation Date:2023-05-13
Deactivation Code:
Reactivation Date:2023-06-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751512Medicaid
MD376751503Medicaid
MD376751508Medicaid
MD376751510Medicaid
MD376751513Medicaid
MD376751500Medicaid
MD376751502Medicaid
MD376751512Medicaid
MDCD7452Medicare PIN
211816Medicare PIN
MD376751513Medicaid
MD376751510Medicaid
211866Medicare PIN
MD376751502Medicaid
211839Medicare PIN
211810Medicare PIN
211815Medicare PIN