Healthcare Provider Details

I. General information

NPI: 1760468623
Provider Name (Legal Business Name): COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W FAYETTE ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

630 W FAYETTE ST
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-209-6204
  • Fax: 410-209-6374
Mailing address:
  • Phone: 410-209-6204
  • Fax: 410-209-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number30072
License Number StateMD

VIII. Authorized Official

Name: MR. ARCHIE WALLACE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 410-209-6201