Provider Demographics
NPI:1417987181
Name:ORTHOPAEDIC SPECIALISTS OF MARYLAND
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-583-0160
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-583-0160
Mailing Address - Fax:410-538-0166
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 606
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-583-0160
Practice Address - Fax:410-538-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI0990OtherRAILROAD MEDICARE
MDKP16OROtherCAREFIRST MARYLAND
DCT441OtherCAREFIRST DC
MDKP16OROtherCAREFIRST MARYLAND