Provider Demographics
NPI:1063634467
Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Entity Type:Organization
Organization Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Other - Org Name:DEER'S HEAD OUTPATIENT UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-4033
Mailing Address - Street 1:351 DEERS HEAD HOSPITAL RD
Mailing Address - Street 2:PO BOX 2018
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-2018
Mailing Address - Country:US
Mailing Address - Phone:410-543-4000
Mailing Address - Fax:410-543-4004
Practice Address - Street 1:351 DEERS HEAD HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21802-2018
Practice Address - Country:US
Practice Address - Phone:410-543-4000
Practice Address - Fax:410-543-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD765203800Medicaid
MD765203800Medicaid