Basic Information
| Provider Information | |||||||||
| NPI: | 1023032471 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARBOR HOSPITAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 S HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3001 S HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 05/20/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MAHESHWARI | ||||||||
| AuthorizedOfficialFirstName: | GOVIND | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | A.V.P | ||||||||
| AuthorizedOfficialTelephone: | 4103503636 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | G759 | 01 | MD | BLUECHOICE | OTHER | DB1627 | 01 | MD | RAILROAD MEDICARE | OTHER | 401897400 | 05 | MD | MEDICAID | 401897404 | 05 | MD | MEDICAID | 435AHA | 01 | MD | CAREFIRST OF MD | OTHER | 401897402 | 05 | MD | MEDICAID | KK25HA | 01 | MD | CAREFIRST OF MD | OTHER | 401897403 | 05 | MD | MEDICAID | 401897401 | 05 | MD | MEDICAID | KEK6 | 01 | MD | CAREFIRST OF MD | OTHER |