Healthcare Provider Details

I. General information

NPI: 1366613465
Provider Name (Legal Business Name): THE GOOD SAMARITAN HOSPITAL OF MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK RD BUILDING C, SUITE 100
LUTHERVILLE MD
21093-6016
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD PROFESSIONAL OFFICE BUILDING, SUITE G-1
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-9768
  • Fax: 410-821-8253
Mailing address:
  • Phone: 443-444-4517
  • Fax: 443-444-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PAUL WILHELM JR.
Title or Position: SERVICE LINE DIRECTOR - ORTHOPAEDIC
Credential:
Phone: 443-444-4517