Provider Demographics
NPI:1114124963
Name:CARROLL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CARROLL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-876-4972
Mailing Address - Street 1:290 S. CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-876-2152
Mailing Address - Fax:410-876-4988
Practice Address - Street 1:6655 SYKESVILLE RD
Practice Address - Street 2:M&S BUILDING, 3RD FLOOR
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7966
Practice Address - Country:US
Practice Address - Phone:410-876-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLL COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1338105251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203313500Medicaid
MD203313500Medicaid