Provider Demographics
NPI:1902802705
Name:BALTIMORE MEDICAL SYSTEM INC
Entity Type:Organization
Organization Name:BALTIMORE MEDICAL SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-558-4891
Mailing Address - Street 1:5525 EASTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2796
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-327-1693
Practice Address - Street 1:3120 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1720
Practice Address - Country:US
Practice Address - Phone:410-558-4800
Practice Address - Fax:410-675-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-06-15
Deactivation Date:2023-05-13
Deactivation Code:
Reactivation Date:2023-06-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751500Medicaid
MD376751502Medicaid
MD376751502Medicaid
MDCD7452Medicare PIN
MD376751500Medicaid