Healthcare Provider Details

I. General information

NPI: 1356032734
Provider Name (Legal Business Name): STATE OF MARYLAND CENTRAL PAYROLL BUREAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29449 CHARLOTTE HALL RD
CHARLOTTE HALL MD
20622-3042
US

IV. Provider business mailing address

16 FRANCIS ST FL 4
ANNAPOLIS MD
21401-1772
US

V. Phone/Fax

Practice location:
  • Phone: 301-884-8171
  • Fax:
Mailing address:
  • Phone: 410-260-3867
  • Fax: 410-216-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER PANTZER
Title or Position: CHIEF OF STAFF
Credential:
Phone: 410-260-3867