| |
600 N Wolfe St Baltimore MD 21287-0005 | |
(410) 955-5000 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 600 N Wolfe St, Baltimore, Maryland |
Authorized Official Name and Position | Shavonda L Keating (SR PRODUCTION UNIT MGR) |
Authorized Official Contact | 4109336430 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 64264 Baltimore MD 21264-4264 Ph: (410) 933-6423 | 600 N Wolfe St Baltimore MD 21287-0005 Ph: (410) 955-5000 |
NPI Number | 1043798259 |
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Provider Enumeration Date | 07/31/2018 |
Last Update Date | 03/07/2021 |
Identifier | Type | State | Issuer |
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1043798259 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (Maryland) | Primary |
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