Organization
MARYLAND SPINE CENTER CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES EDWARDS, II (TITLE)
(410) 659-2802
Entity
Organization
Contact information
Practice address
301 ST PAUL PLACE, SPINE CENTER, LOWER LEVEL, BALTIMORE, MD 21202
(410) 539-3434
(410) 366-2202
Mailing address
PO BOX 418375, BOSTON, MA 02241-8375
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374002100
—
MD
01
—
F 482
BLUE CHOICE
MD
01
—
LZ51
BC / BS OF MD
—
Enumeration date
08/23/2006
Last updated
07/02/2013
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