Basic Information
| Provider Information | |||||||||
| NPI: | 1427280866 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARFORD COUNTY HEALTH DEPARTMENT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HCHD HALLS CROSS ROADS ELEMENTARY - 1427280866 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 S HAYS ST | ||||||||
| Address2: | ATTN MARCY AUSTIN | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210143615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108771033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 E BEL AIR AVE | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210013814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108771033 | ||||||||
| FaxNumber: | 4104203435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2009 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DEPUTY HEALTH OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4108771033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HARFORD COUNTY HEALTH DEPARTMENT | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
ID Information
| ID | Type | State | Issuer | Description | 411302100 | 05 | MD | MEDICAID |