Provider Demographics
NPI:1639293228
Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Other - Org Name:ACHD-DENTAL PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:301-759-5001
Mailing Address - Street 1:PO BOX 1745
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1745
Mailing Address - Country:US
Mailing Address - Phone:301-759-5000
Mailing Address - Fax:301-777-5674
Practice Address - Street 1:12503 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2554
Practice Address - Country:US
Practice Address - Phone:301-759-5030
Practice Address - Fax:301-722-4304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGANY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD722001500Medicaid
MD720001300Medicaid