Provider Demographics
NPI:1164813978
Name:HEALTH NETWORK OF MARYLAND
Entity Type:Organization
Organization Name:HEALTH NETWORK OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSWC
Authorized Official - Phone:410-977-9555
Mailing Address - Street 1:2501 HAL CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2621
Mailing Address - Country:US
Mailing Address - Phone:410-977-9555
Mailing Address - Fax:443-388-9535
Practice Address - Street 1:2501 HAL CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2621
Practice Address - Country:US
Practice Address - Phone:410-977-9555
Practice Address - Fax:443-388-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03614251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511501900Medicaid