Healthcare Provider Details

I. General information

NPI: 1598789943
Provider Name (Legal Business Name): THE GOOD SAMARITAN HOSPITAL OF MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-8000
  • Fax:
Mailing address:
  • Phone: 443-444-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEANA STOUT
Title or Position: V.P. FINANCE
Credential:
Phone: 443-444-3841