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4601 Liberty Heights Ave Baltimore MD 21207-7553 | |
(443) 884-7577 | |
(667) 239-3121 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 4601 Liberty Heights Ave, Baltimore, Maryland |
Authorized Official Name and Position | Elizabeth Lee (CFO) |
Authorized Official Contact | 4105427800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4601 Liberty Heights Ave Baltimore MD 21207-7553 Ph: (410) 542-7800 | 4601 Liberty Heights Ave Baltimore MD 21207-7553 Ph: (443) 884-7577 |
NPI Number | 1073914206 |
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Provider Enumeration Date | 09/08/2014 |
Last Update Date | 11/03/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073914206 | NPI | - | NPPES |
912391100 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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