Provider Demographics
NPI:1245694520
Name:SHORE ORTHOPEDICS, INC
Entity type:Organization
Organization Name:SHORE ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-820-8226
Mailing Address - Street 1:510 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3881
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:410-820-8405
Practice Address - Street 1:510 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3881
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:410-820-8405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-12
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCF17OtherCAREFIRST
MD8740763-00Medicaid
MDCF17OtherCAREFIRST