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1578571337

NPI Code Detail

MEDICARE: IDF-TRINITY CENTER

MEDICARE: IDF-TRINITY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	E2560	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0704865003	OTHER	MD	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	215143	OTHER	MD	MDIPA
4	21506	OTHER	MD	JAI MEDICAL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0125608	OTHER	MD	AETNA
7	590080-01	OTHER	MD	CAREFIRST
8	PS7	OTHER	MD	FEP

General Provider Information

NPI Number	:	1578571337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDF-TRINITY CENTER

Provider Business Mailing Address
First Line	:	840 HOLLINS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1024
Country	:	US
Telephone Number	:	410-468-0900
Fax Number	:	410-468-0911

Provider Business Practice Location Address
First Line	:	3000 N RIDGE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3311
Country	:	US
Telephone Number	:	410-468-0900
Fax Number	:	410-468-0911

Authorized Official
Title or Position	:	DIRECTOR OF INFORMATION SYSTEMS
Name	:	ZEKE AYELE
Credential	:
Telephone Number	:	410-468-0900

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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Directions to “IDF-TRINITY CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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