Provider Demographics
NPI:1437190865
Name:BALTIMORE WORK REHABILITATION
Entity type:Organization
Organization Name:BALTIMORE WORK REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YALICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-933-8494
Mailing Address - Street 1:3 NASHUA CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3133
Mailing Address - Country:US
Mailing Address - Phone:443-579-1062
Mailing Address - Fax:410-933-4835
Practice Address - Street 1:7138 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2904
Practice Address - Country:US
Practice Address - Phone:410-590-9898
Practice Address - Fax:410-590-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBC3BAOtherCAREFIRST
MD247MMedicare ID - Type Unspecified