Organization
PHYSICIAN GROUP WPCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARCHIE T. WALLACE MBA (CEO)
(410) 209-6201
Entity
Organization
Contact information
Practice address
630 W FAYETTE ST, BALTIMORE, MD 21201-1543
(410) 209-6201
(410) 209-6209
Mailing address
630 W FAYETTE ST, BALTIMORE, MD 21201-1543
(410) 209-6201
(410) 209-6209
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
—
MD
Other
Enumeration date
01/30/2007
Last updated
08/22/2020
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