Provider Demographics
NPI:1760468623
Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Entity Type:Organization
Organization Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Other - Org Name:WALTER P. CARTER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-209-6201
Mailing Address - Street 1:630 W FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-209-6204
Mailing Address - Fax:410-209-6374
Practice Address - Street 1:630 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-209-6204
Practice Address - Fax:410-209-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30072283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214011Medicare ID - Type Unspecified
MDK742Medicare PIN