Provider Demographics
NPI:1437396959
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:VICE PRESIDENT 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:443-444-3841
Mailing Address - Street 1:5601LOCH RAVEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2095
Mailing Address - Country:US
Mailing Address - Phone:443-444-4663
Mailing Address - Fax:
Practice Address - Street 1:5601LOCH RAVEN BLVD.
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2095
Practice Address - Country:US
Practice Address - Phone:443-444-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK496OtherCAREFIRST BC/BS BLUECHOICE DC
MD412532100Medicaid
MDFY01GOOtherCAREFIRST BC/BS MARYLAND
MDKL90Medicare PIN