Provider Demographics
NPI:1912101064
Name:METRO TREATMENT OF MARYLAND
Entity Type:Organization
Organization Name:METRO TREATMENT OF MARYLAND
Other - Org Name:HAGERSTOWN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING
Authorized Official - Phone:301-714-0837
Mailing Address - Street 1:217 E ANTIETAM ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5724
Mailing Address - Country:US
Mailing Address - Phone:301-714-0837
Mailing Address - Fax:301-714-2931
Practice Address - Street 1:217 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-714-0837
Practice Address - Fax:301-714-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone