Basic Information
| Provider Information | |||||||||
| NPI: | 1609010925 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANKLIN SQUARE HOSPITAL CENTER INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | MID ATLANTIC INCONTINENCE CENTER AT FRANKLIN SQUARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9103 FRANKLIN SQUARE DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212373900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437777608 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9103 FRANKLIN SQUARE DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212373900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437777608 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHARKEY | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER, PROFESSIONAL FEE BILLING | ||||||||
| AuthorizedOfficialTelephone: | 4437777142 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 042291609 | 05 | MD | MEDICAID |