| |
1000 S Marlyn Ave Baltimore MD 21221-5939 | |
(410) 887-4130 | |
(410) 666-8748 |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 1000 S Marlyn Ave, Baltimore, Maryland |
Authorized Official Name and Position | David C Taylor (PRIVACY OFFICER) |
Authorized Official Contact | 4108872077 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6401 York Rd 3rd Floor Baltimore MD 21212-2152 Ph: (410) 887-2077 | 1000 S Marlyn Ave Baltimore MD 21221-5939 Ph: (410) 887-4130 |
NPI Number | 1134499213 |
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Provider Enumeration Date | 01/06/2012 |
Last Update Date | 04/22/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134499213 | NPI | - | NPPES |
420941900 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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