Provider Demographics
NPI:1598789943
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:443-444-3841
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:443-444-8000
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:443-444-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8128OtherCAREFIRST BC/BS DC
MDFY02GOOtherCAREFIRST BC/BS
MDW414OtherCAREFIRST BC/BS DC
MD82FHGOOtherCAREFIRST BC/BS
MD852963900Medicaid
MD414461900Medicaid
MDDN1416OtherMEDICARE RAILROAD CARRIER
MDFY02Medicare PIN