Active NPI
G Robert Medalie, MD
- Cardiovascular Disease Physician
- Baltimore, MD
National Provider Identifier
1083621676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- D0021398
- Practice address
- 6535 N Charles Street
Suite 325
Baltimore, MD 21204-5824 - Phone
- (410) 321-9701
- Fax
- (410) 321-0845
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | D0021398 | MD | Primary |
Addresses
Primary practice location
6535 N Charles Street
Suite 325
Baltimore, MD 21204-5824
Mailing address
6535 N Charles Street
Suite 325
Baltimore, MD 21204-5824
Phone (410) 321-9701
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060057954 | Other | MD | RAILROAD MEDICARE |
| 138731600 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0021398 | MD | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph Physician Enterprise | Past | Accepting new patients | |
| Saint Joseph Medical Center , Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Towson, MD
- NPI 1699862961
-
- Multi-Specialty Clinic/Center
- Towson, MD
- NPI 1518143304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1083621676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6535 N CHARLES STREET",
"address_2": "SUITE 325",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212045824",
"telephone_number": "410-321-9701",
"fax_number": "410-321-0845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6535 N CHARLES STREET",
"address_2": "SUITE 325",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212045824",
"telephone_number": "410-321-9701",
"fax_number": "410-321-0845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDALIE",
"first_name": "G",
"middle_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MD",
"license": "D0021398",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "060057954",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "138731600",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.