Provider Demographics
NPI:1750696985
Name:SINAI HOSPITAL OF BALTIMORE, INC
Entity type:Organization
Organization Name:SINAI HOSPITAL OF BALTIMORE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:EFIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-7019
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-549-2000
Mailing Address - Fax:410-549-2103
Practice Address - Street 1:6190 GEORGETOWN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6460
Practice Address - Country:US
Practice Address - Phone:410-549-2000
Practice Address - Fax:410-549-2103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINAI HOSPITAL OF BALTIMORE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440067400Medicaid
MD194791Medicare PIN