Provider Demographics
NPI:1407870850
Name:THE GOOD SAMARITAN HOSPITAL OF MARYLAND INC
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HOSPITAL OF MARYLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-532-3905
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:410-532-8000
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-532-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126001400Medicaid
MD219081800Medicaid
MD8912OtherCAREFIRST BC/BS DC
MDG977OtherCAREFIRST BC/BS DC
MDW606OtherCAREFIRST BC/BS DC
MD9329OtherCAREFIRST BC/BS DC
MDCA4406OtherRAILROAD MEDICARE
MDK496OtherCAREFIRST BC/BS DC
MDKL90GOOtherCAREFIRST BC/BS
MDW617OtherCAREFIRST BC/BS DC
MD412532100Medicaid
MDFY01GOOtherCAREFIRST BC/BS
MDJ429OtherCAREFIRST DC
MDCA3416OtherRAILROAD MEDICARE
MDCA4406Medicare PIN
MDCA4406OtherRAILROAD MEDICARE
MD126001400Medicaid