Healthcare Provider Details

I. General information

NPI: 1578571337
Provider Name (Legal Business Name): IDF-TRINITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N RIDGE RD
ELLICOTT CITY MD
21043-3311
US

IV. Provider business mailing address

840 HOLLINS ST
BALTIMORE MD
21201-1024
US

V. Phone/Fax

Practice location:
  • Phone: 410-468-0900
  • Fax: 410-468-0911
Mailing address:
  • Phone: 410-468-0900
  • Fax: 410-468-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberE2560
License Number StateMD

VIII. Authorized Official

Name: ZEKE AYELE
Title or Position: DIRECTOR OF INFORMATION SYSTEMS
Credential:
Phone: 410-468-0900