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

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 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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