Basic Information
| Provider Information | |||||||||
| NPI: | 1952591547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME PHYSICIANS BALTIMORE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 COOL SPRINGS BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370677331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732924800 | ||||||||
| FaxNumber: | 3125644059 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S CALVERT ST STE 1600 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212026106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732924900 | ||||||||
| FaxNumber: | 3125644059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | WALES | ||||||||
| AuthorizedOfficialFirstName: | DIRK | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6155643511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.