Basic Information
| Provider Information | |||||||||
| NPI: | 1205826724 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WASHINGTON COUNTY EMERGENCY MEDICINE PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631479 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212631479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012930232 | ||||||||
| FaxNumber: | 3016311002 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 E ANTIETAM ST | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217405724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403139500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 3017908372 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
| ID | Type | State | Issuer | Description | S467 | 01 | MD | BCBS FEDERAL | OTHER | 0017209190002 | 05 | PA | MEDICAID | 4000113000 | 05 | WV | MEDICAID | KF18 | 01 | MD | BCBS | OTHER | CI1661 | 01 | MD | RAILROAD MEDICARE | OTHER |