| Fallstaff Tbs 1:1 | |
|
6999 Reisterstown Rd Suite 9 Baltimore MD 21215-1430 | |
| (410) 585-0598 | |
| Not Available |
| Full Name | Fallstaff Tbs 1:1 |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 6999 Reisterstown Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Gloria Reeves (ACCOUNTS RECEIVABLE AND BILLING MAN) |
| Authorized Official Contact | 6766002249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fallstaff Tbs 1:1 2300 Dulaney Valley Rd Timonium MD 21093-2739 Ph: (667) 600-2249 | Fallstaff Tbs 1:1 6999 Reisterstown Rd Suite 9 Baltimore MD 21215-1430 Ph: (410) 585-0598 |
| NPI Number | 1295097079 |
|---|---|
| Provider Enumeration Date | 06/08/2012 |
| Last Update Date | 01/03/2020 |
| Certification Date | 01/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295097079 | NPI | - | NPPES |
| 421122700 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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