=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477513273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE HEALTH SYSTEM, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 09/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MARTIN CT
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-7778
-----------------------------------------------------
Fax | 410-820-8862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 S WASHINGTON ST
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-822-1000
-----------------------------------------------------
Fax | 410-770-3836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. KENNETH KOZEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-822-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------