Provider Demographics
NPI:1730388711
Name:BALTIMORE WASHINGTON GASTROENTEROLOGY PA
Entity type:Organization
Organization Name:BALTIMORE WASHINGTON GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-905-6436
Mailing Address - Street 1:PO BOX 8198
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8198
Mailing Address - Country:US
Mailing Address - Phone:410-435-3023
Mailing Address - Fax:410-435-3025
Practice Address - Street 1:1900 E NORTHERN PKWY
Practice Address - Street 2:SUITE 305A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:410-435-3023
Practice Address - Fax:410-435-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214PMedicare PIN