Basic Information
| Provider Information | |||||||||
| NPI: | 1609990258 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1745 | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215011745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017595000 | ||||||||
| FaxNumber: | 3017775674 | ||||||||
| Practice Location | |||||||||
| Address1: | 12501 WILLOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215022554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017595093 | ||||||||
| FaxNumber: | 3017775669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAVER | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HEALTH OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3017595001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, MHP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 323817 | 01 | MD | VALUE OPTIONS | OTHER | 147701060 | 01 | MD | MPC | OTHER | K002K0 | 01 | MD | MAGELLAN BEHAVIORAL HEALT | OTHER | 1059446 | 01 | MD | CIGNA | OTHER | 55752NO | 01 | MD | PRIORITY PARTNERS | OTHER | 8480502 | 01 | MD | UNITED HEALTH CARE | OTHER | 702001500 | 05 | MD | MEDICAID | 720001300 | 05 | MD | MEDICAID | 0180409 | 01 | MD | UNITED HEALTH CARE | OTHER | 351541 | 01 | MD | MAMSI (MDIPA, MAMSI LIFE | OTHER | NU1 | 01 | MD | GHMSI (FEP, BLUE CHOICE) | OTHER | VA01 | 01 | MD | BCBS | OTHER |