Provider Demographics
NPI:1093946709
Name:CORRECTIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:CORRECTIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATEWIDE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASRESAHEGN
Authorized Official - Middle Name:
Authorized Official - Last Name:GETACHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-872-8590
Mailing Address - Street 1:7816 FOXFARM LN
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6321
Mailing Address - Country:US
Mailing Address - Phone:443-749-4843
Mailing Address - Fax:
Practice Address - Street 1:7943 BROCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9704
Practice Address - Country:US
Practice Address - Phone:410-379-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058537261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH81548Medicare UPIN
MDH446F619Medicare PIN