Provider Demographics
NPI:1508035635
Name:CECIL COUNTY
Entity Type:Organization
Organization Name:CECIL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN BUDGET ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-392-2012
Mailing Address - Street 1:200 CHESAPEAKE BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 CHESAPEAKE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6390
Practice Address - Country:US
Practice Address - Phone:410-392-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146L00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122098500Medicaid