Basic Information
| Provider Information | |||||||||
| NPI: | 1245952415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARYLAND GENERAL CLINICAL PRACTICE GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ELKRIDGE LANDING RD FL 2 | ||||||||
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| City: | LINTHICUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210902924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434625010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 LINDEN AVE | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212014622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435522432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2022 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | ALISON | ||||||||
| AuthorizedOfficialMiddleName: | GATES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4102258614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Health Educator |
No ID Information.