Provider Demographics
NPI:1174514996
Name:COMPTROLLER OF MARYLAND, CENTRAL PAYROLL BUREAU
Entity type:Organization
Organization Name:COMPTROLLER OF MARYLAND, CENTRAL PAYROLL BUREAU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PELLEGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN MED
Authorized Official - Phone:301-791-4410
Mailing Address - Street 1:PO BOX 2964
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-2964
Mailing Address - Country:US
Mailing Address - Phone:410-543-4132
Mailing Address - Fax:410-543-4140
Practice Address - Street 1:1500 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3112
Practice Address - Country:US
Practice Address - Phone:301-745-3748
Practice Address - Fax:301-745-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21013261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD472501800Medicaid
MDPH7OtherCAREFIRST BCBS PLANS
MD02R7OtherCAREFIRST BCBS PLANS
MD212314Medicare ID - Type Unspecified