Organization
BALTIMORE WASHINGTON PROFESSIONAL SERVICES INC.
Active
Other names
BWMC SURGICAL ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO NOEL (MANAGED CARE COORDINATOR)
(410) 787-4594
Entity
Organization
Contact information
Practice address
301 HOSPITAL DR, GLEN BURNIE, MD 21061-5803
(410) 787-4594
Mailing address
PO BOX 64584, BALTIMORE, MD 21264-4584
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
MD
207VG0400X
Gynecology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165767
MEDICARE PTAN
MD
01
—
DB3GBW
BLUE CROSS BLUE SHIELD
MD
01
—
Q818
BLUE CROSS BLUE SHIELD
MD
01
—
ZEZT
MEDICARE GROUP
MD
Enumeration date
10/26/2007
Last updated
01/30/2015
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