1568453306 NPI number — COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568453306 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:
UPPER SHORE COMMUNITY MENTAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1568453306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SCHEELER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-778-6800
Provider Business Mailing Address Fax Number:
410-221-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SCHEELER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-778-6800
Provider Business Practice Location Address Fax Number:
410-221-2534
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NOREN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
410-221-2527

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  14-001 , 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)





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