NPIMap

Organization Active NPI

Loch Raven CLC

  • Rehabilitation Hospital Unit
  • Baltimore, MD
National Provider Identifier
1639475809
Registry record updated Feb 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
16012 Issued in MD
Legal business name
LOCH RAVEN CLC
Practice address
3900 Loch Raven Blvd
Baltimore, MD 21218-2108
Phone
(410) 605-7000
Fax
(410) 605-7589
NPI assigned
Feb 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sondra Hardy Otukoya, CTRSNPI 1891091096
Title
Recreation Recreation
Phone
(410) 605-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 16012 MD Primary

Addresses

Primary practice location

3900 Loch Raven Blvd
Baltimore, MD 21218-2108

Mailing address

3900 Loch Raven Blvd.
Baltimore, MD 21218
Phone (410) 605-7000

Other names 1

  • VETERANS AFFAIRS Former legal business name

National Provider Directory

National Provider Directory

Locations

3900 Loch Raven Blvd
Baltimore, MD 21218
Phone (410) 605-7620

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296777600000",
    "number": "1639475809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 LOCH RAVEN BLVD.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21218",
            "telephone_number": "410-605-7000",
            "fax_number": "410-605-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 LOCH RAVEN BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212182108",
            "telephone_number": "410-605-7000",
            "fax_number": "410-605-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCH RAVEN CLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-04",
        "last_updated": "2011-02-04",
        "status": "A",
        "authorized_official_last_name": "OTUKOYA",
        "authorized_official_first_name": "SONDRA",
        "authorized_official_middle_name": "HARDY",
        "authorized_official_title_or_position": "RECREATION RECREATION",
        "authorized_official_telephone_number": "410-605-7000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CTRS"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MD",
            "license": "16012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VETERANS AFFAIRS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Feb 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.