Provider Demographics
NPI:1740275106
Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Entity type:Organization
Organization Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-777-2260
Mailing Address - Street 1:PO BOX 1722
Mailing Address - Street 2:COUNTRY CLUB ROAD SE
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1722
Mailing Address - Country:US
Mailing Address - Phone:301-777-2405
Mailing Address - Fax:301-777-2364
Practice Address - Street 1:10102 COUNTRY CLUB RD SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8339
Practice Address - Country:US
Practice Address - Phone:301-777-2405
Practice Address - Fax:301-777-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-009283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214012Medicare ID - Type Unspecified
MDK745Medicare PIN