Basic Information
| Provider Information | |||||||||
| NPI: | 1285791871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNE ARUNDEL MEDICAL CENTER, INC | ||||||||
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| OtherOrganizationName: | ANNE ARUNDEL MEDICAL CENTER-OBGYN HOSPITALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62280 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212640001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816520 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PKWY | ||||||||
| Address2: | ACUTE CARE PAVILION | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | STEOHEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4434816558 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 250AAA | 01 | MD | CAREFIRST | OTHER | 5588 | 01 | DC | CAREFIRST | OTHER | 210169 | 01 | MD | JOHN HOPKINS HC | OTHER | 2486501 | 01 | MD | AETNA HMO | OTHER | 7367692 | 01 | MD | AETNA PPO | OTHER |