Provider Demographics
NPI:1659899763
Name:SHORE HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:SHORE HEALTH SYSTEM INC
Other - Org Name:DENTON DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-822-1000
Mailing Address - Street 1:1140 BLADES FARM RD
Mailing Address - Street 2:STE 102
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-3459
Mailing Address - Country:US
Mailing Address - Phone:410-479-3510
Mailing Address - Fax:410-479-3527
Practice Address - Street 1:1140 BLADES FARM ROAD
Practice Address - Street 2:STE 102
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-3459
Practice Address - Country:US
Practice Address - Phone:410-479-3510
Practice Address - Fax:410-479-3527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology