Healthcare Provider Details

I. General information

NPI: 1770184558
Provider Name (Legal Business Name): SHORE HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BYRN ST
CAMBRIDGE MD
21613-1908
US

IV. Provider business mailing address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-5511
  • Fax:
Mailing address:
  • Phone: 410-822-1000
  • Fax: 410-822-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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