Provider Demographics
NPI:1689677783
Name:MARYLAND GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARYLAND GENERAL HOSPITAL, INC.
Other - Org Name:UMMC MTC CENTER FOR ADDICTION MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-5670
Mailing Address - Street 1:PO BOX 69043
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9039
Mailing Address - Country:US
Mailing Address - Phone:717-428-0552
Mailing Address - Fax:
Practice Address - Street 1:827 LINDEN AVE STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4606
Practice Address - Country:US
Practice Address - Phone:410-225-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD792304000Medicaid
MDD74621Medicare UPIN
MD672L297DMedicare ID - Type Unspecified