Basic Information
| Provider Information | |||||||||
| NPI: | 1770589533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARFORD MEMORIAL HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S UNION AVE | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438435000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S UNION AVE | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438435000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | PRIOLO | ||||||||
| AuthorizedOfficialFirstName: | MARCUS | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS AUGUSTUS | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4436433340 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 12004 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000255100 | 05 | MD | MEDICAID |