Provider Demographics
NPI:1629649629
Name:GREATER MARYLAND ORTHOPEDICS
Entity Type:Organization
Organization Name:GREATER MARYLAND ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-319-6689
Mailing Address - Street 1:5570 STERRETT PL STE 206
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2674
Mailing Address - Country:US
Mailing Address - Phone:667-240-2738
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL STE 206
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2674
Practice Address - Country:US
Practice Address - Phone:667-240-2738
Practice Address - Fax:443-546-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD72683OtherMEDICAL LICENSE