Provider Demographics
NPI:1144338815
Name:EASTER SEALS BALTIMORE-WASHINGTON
Entity type:Organization
Organization Name:EASTER SEALS BALTIMORE-WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-931-8700
Mailing Address - Street 1:4041 POWDER MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-931-8700
Mailing Address - Fax:301-931-1516
Practice Address - Street 1:111 NORTH CHERRY ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-534-5354
Practice Address - Fax:703-534-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496576Medicare ID - Type Unspecified