Healthcare Provider Details

I. General information

NPI: 1801475637
Provider Name (Legal Business Name): SHORE HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/23/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 CAMBRIDGE MARKETPLACE BLVD STE 2-600
CAMBRIDGE MD
21613
US

IV. Provider business mailing address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1000
  • Fax:
Mailing address:
  • Phone: 410-822-1000
  • Fax: 410-822-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH KOZEL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 410-822-1000