1295726594 NPI number — COMPTROLLER OF MARYLAND, CENTRAL PAYROLL BUREAU

Table of content: (NPI 1295726594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295726594 NPI number — COMPTROLLER OF MARYLAND, CENTRAL PAYROLL BUREAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPTROLLER OF MARYLAND, CENTRAL PAYROLL BUREAU
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295726594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2964
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-4132
Provider Business Mailing Address Fax Number:
410-543-4140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 DEERS HEAD HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-4132
Provider Business Practice Location Address Fax Number:
410-543-4140
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WAIDE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-543-4010

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  22001 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 472491700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59022301 02R8 PH8 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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