Provider Demographics
NPI:1760412126
Name:EASTERN SHORE HOSPITAL CENTER/PHYSICIAN GROUP
Entity Type:Organization
Organization Name:EASTERN SHORE HOSPITAL CENTER/PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NOREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-221-2525
Mailing Address - Street 1:5262 WOODS RD
Mailing Address - Street 2:EASTERN SHORE HOSPITAL CENTER
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3796
Mailing Address - Country:US
Mailing Address - Phone:410-221-2300
Mailing Address - Fax:
Practice Address - Street 1:5262 WOODS RD
Practice Address - Street 2:EASTERN SHORE HOSPITAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3796
Practice Address - Country:US
Practice Address - Phone:410-221-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09003283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital