Basic Information
Provider Information
NPI: 1740469774
EntityType: 2
ReplacementNPI:  
OrganizationName: BALTIMORE WASHINGTON MEDICAL CENTER INC.
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Mailing Information
Address1: 301 HOSPITAL DR
Address2:  
City: GLEN BURNIE
State: MD
PostalCode: 210615803
CountryCode: US
TelephoneNumber: 4107874000
FaxNumber:  
Practice Location
Address1: 301 HOSPITAL DR
Address2:  
City: GLEN BURNIE
State: MD
PostalCode: 210615803
CountryCode: US
TelephoneNumber: 4107874000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/26/2007
LastUpdateDate: 06/20/2012
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AuthorizedOfficialLastName: PAESCH
AuthorizedOfficialFirstName: REBECCA
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 4107874879
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

ID Information
IDTypeStateIssuerDescription
77534110005MD MEDICAID


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