Provider Demographics
NPI:1790867802
Name:VETERANS AFFAIRS MARYLAND HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VETERANS AFFAIRS MARYLAND HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CLINICAL AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:BRANDILYN
Authorized Official - Last Name:SPYIES
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:410-605-7000
Mailing Address - Street 1:118 N HOWARD ST
Mailing Address - Street 2:APT 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3424
Mailing Address - Country:US
Mailing Address - Phone:410-528-8945
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01116302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization