Provider Demographics
NPI:1407815988
Name:PROCARE AMBULANCE OF MARYLAND INC
Entity Type:Organization
Organization Name:PROCARE AMBULANCE OF MARYLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:AILIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-823-0030
Mailing Address - Street 1:2037 ROSETTA WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035
Mailing Address - Country:US
Mailing Address - Phone:410-823-0030
Mailing Address - Fax:410-823-7475
Practice Address - Street 1:6953 GOLDEN RING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3033
Practice Address - Country:US
Practice Address - Phone:410-823-0030
Practice Address - Fax:410-823-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTR75OtherBCBS
454SMedicare ID - Type Unspecified
MDTR75OtherBCBS