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General NPI Number Information
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NPI Number | 1093946709
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Entity Type | Organization
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Legal Business Name | CORRECTIONAL MEDICAL SERVICES
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 7943 BROCK BRIDGE RD
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City | JESSUP
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State | MD
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Zip | 20794-9704
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Country | US
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Telephone | 410-379-3873
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Fax |
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Provider Business Mailing Address
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Address Line | 7816 FOXFARM LN
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City | GLEN BURNIE
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State | MD
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Zip | 21061-6321
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Country | US
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Telephone | 443-749-4843
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Fax |
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Authorized Official
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Title or Position | STATEWIDE MEDICAL DIRECTOR
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Name | DR. ASRESAHEGN GETACHEW
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Credential | M.D.
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Telephone | 410-872-8590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | D0058537
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License Number State | MD
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