Provider Demographics
NPI:1497003446
Name:MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER INC
Entity Type:Organization
Organization Name:MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER INC
Other - Org Name:SUBACUTE CARE CENTER AT MEDSTAR SOUNTHERN MARYLAND HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-772-6707
Mailing Address - Street 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-868-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility