Provider Demographics
NPI:1043200900
Name:MARYLAND CENTER FOR DIGESTIVE HEALTH
Entity Type:Organization
Organization Name:MARYLAND CENTER FOR DIGESTIVE HEALTH
Other - Org Name:MCDH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-1524
Mailing Address - Street 1:171 DEFENSE HWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7004
Mailing Address - Country:US
Mailing Address - Phone:410-571-1524
Mailing Address - Fax:410-224-4960
Practice Address - Street 1:171 DEFENSE HWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7004
Practice Address - Country:US
Practice Address - Phone:410-571-1524
Practice Address - Fax:410-224-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDZZ50Medicare ID - Type Unspecified