Provider Demographics
NPI:1376758110
Name:MARYLAND SPORTSCARE & REHAB LLC
Entity Type:Organization
Organization Name:MARYLAND SPORTSCARE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-876-8076
Mailing Address - Street 1:511 JERMOR LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6151
Mailing Address - Country:US
Mailing Address - Phone:410-876-8076
Mailing Address - Fax:
Practice Address - Street 1:511 JERMOR LN
Practice Address - Street 2:SUITE B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6151
Practice Address - Country:US
Practice Address - Phone:410-876-8076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04081332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4943950001Medicare NSC
969LMedicare ID - Type Unspecified