Provider Demographics
NPI:1861577645
Name:BALTIMORE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:BALTIMORE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:KIRWAN
Authorized Official - Last Name:WARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-887-4456
Mailing Address - Street 1:4222 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1752
Mailing Address - Country:US
Mailing Address - Phone:301-864-7895
Mailing Address - Fax:
Practice Address - Street 1:1740 TWIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3526
Practice Address - Country:US
Practice Address - Phone:410-887-4456
Practice Address - Fax:410-887-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121844261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center