Basic Information
Provider Information
NPI: 1275855702
EntityType: 2
ReplacementNPI:  
OrganizationName: BALTIMORE WASHINGTON PROFESSIONAL SERVICES INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BWMC VASCULAR ASSOCIATES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 62507
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212645803
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 301 HOSPITAL DR
Address2: FIRST FLOOR
City: GLEN BURNIE
State: MD
PostalCode: 210615803
CountryCode: US
TelephoneNumber: 4105538300
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2010
LastUpdateDate: 03/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PAESCH
AuthorizedOfficialFirstName: REBECCA
AuthorizedOfficialMiddleName: L.
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 4107874879
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0129X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery

No ID Information.


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