Provider Demographics
NPI:1770691024
Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES EDUCATOR/DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SUTAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CDE
Authorized Official - Phone:301-475-6185
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:HEALTH CONNECTIONS
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0527
Mailing Address - Country:US
Mailing Address - Phone:301-475-6185
Mailing Address - Fax:301-475-6143
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:HEALTH CONNECTIONS
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-0527
Practice Address - Country:US
Practice Address - Phone:301-475-6185
Practice Address - Fax:301-475-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO0679282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211539Medicaid
MD211539Medicare ID - Type Unspecified