Provider Demographics
NPI:1629438528
Name:MARYLAND DEPARTMENT OF AGING
Entity Type:Organization
Organization Name:MARYLAND DEPARTMENT OF AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF LTSS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-767-1266
Mailing Address - Street 1:301 W PRESTON ST
Mailing Address - Street 2:SUITE 1007
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2305
Mailing Address - Country:US
Mailing Address - Phone:410-767-1017
Mailing Address - Fax:410-333-5410
Practice Address - Street 1:301 W PRESTON ST
Practice Address - Street 2:SUITE 1007
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2305
Practice Address - Country:US
Practice Address - Phone:410-767-1017
Practice Address - Fax:410-333-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care