Provider Demographics
NPI:1851324164
Name:SHEPPARD PRATT HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SHEPPARD PRATT HEALTH SYSTEM, INC.
Other - Org Name:SHEPPARD PRATT AT ELLICOTT CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-938-5046
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3150
Mailing Address - Fax:410-938-3159
Practice Address - Street 1:7220 DISCOVERY DRIVE
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075
Practice Address - Country:US
Practice Address - Phone:410-938-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPPARD PRATT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13-002283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5-52770Medicaid
MDNR5OtherCAREFIRST FACILITY #
MD13-002OtherMD FACILITY LICS
MDNR5OtherCAREFIRST FACILITY #
MDMDD15818Medicare UPIN