1366613465 NPI number — THE GOOD SAMARITAN HOSPITAL OF MD, INC

Table of content: (NPI 1366613465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366613465 NPI number — THE GOOD SAMARITAN HOSPITAL OF MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GOOD SAMARITAN HOSPITAL OF MD, INC
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:
1366613465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 LOCH RAVEN BLVD
Provider Second Line Business Mailing Address:
PROFESSIONAL OFFICE BUILDING, SUITE G-1
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21239-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-444-4517
Provider Business Mailing Address Fax Number:
443-444-4752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 YORK RD
Provider Second Line Business Practice Location Address:
BUILDING C, SUITE 100
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-9768
Provider Business Practice Location Address Fax Number:
410-821-8253
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILHELM
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
SERVICE LINE DIRECTOR - ORTHOPAEDIC
Authorized Official Telephone Number:
443-444-4517

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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