Provider Demographics
NPI:1972774925
Name:THE GOOD SAMARITAN HOSPITAL OF MD, INC
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HOSPITAL OF MD, INC
Other - Org Name:JOHNS HOPKINS ORTHOPAEDICS AT GSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE LINE DIRECTOR - ORTHOPAEDIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:443-444-4517
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING, SUITE G-1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:443-444-4517
Mailing Address - Fax:443-444-4752
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING, SUITE G-1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:443-444-4517
Practice Address - Fax:443-444-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0660300001Medicare NSC