Provider Demographics
NPI:1912930835
Name:FITNESS FORUM OF MARYLAND, LLC
Entity Type:Organization
Organization Name:FITNESS FORUM OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-831-3226
Mailing Address - Street 1:659 S SALISBURY BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5453
Mailing Address - Country:US
Mailing Address - Phone:410-831-3226
Mailing Address - Fax:410-572-4041
Practice Address - Street 1:2448 HOLLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3148
Practice Address - Country:US
Practice Address - Phone:410-295-4941
Practice Address - Fax:410-295-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147433400OtherACS - US DEPT OF LABOR
DCT671OtherBCBS OF DC
MD2195313OtherFIRST HEALTH NETWORK
MD147433401OtherACS - US DEPT OF LABOR
MDKC41FIOtherBCBS OF MARYLAND
MD1784629OtherUNITED HEALTHCARE
MD2195313OtherCCN NETWORK
MD57731OtherJOHNS HOPKINS HEALTHCARE
MD2195313OtherCCN NETWORK