Healthcare Provider Details

I. General information

NPI: 1659899763
Provider Name (Legal Business Name): SHORE HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 BLADES FARM ROAD STE 102
DENTON MD
21629-3459
US

IV. Provider business mailing address

1140 BLADES FARM RD STE 102
DENTON MD
21629-3459
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-3510
  • Fax: 410-479-3527
Mailing address:
  • Phone: 410-479-3510
  • Fax: 410-479-3527

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 D KOZEL
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 410-822-1000