Basic Information
| Provider Information | |||||||||
| NPI: | 1235395138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GOOD SAMARITAN HOSPITAL OF MARYLAND INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434448000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434448000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | STOUT | ||||||||
| AuthorizedOfficialFirstName: | DEANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | V.P. FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4105323905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 30029 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0200X | 30029 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 82FHGO | 01 | MD | CAREFIRST BLUECROSS BLUESHIELD MD | OTHER | 8128 | 01 | MD | CAREFIRST BLUECROSS BLUE SHIELD DC | OTHER | 414461900 | 05 | MD | MEDICAID |