Provider Demographics
NPI:1932269495
Name:SHEPPARD PRATT HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:SHEPPARD PRATT HEALTH SYSTEM, INC
Other - Org Name:SHEPPARD PRATT - BALTIMORE/WASHINGTON CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, PATIENT FISCAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-938-5046
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3000
Mailing Address - Fax:410-938-3159
Practice Address - Street 1:7220 DISCOVERY DRIVE
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075
Practice Address - Country:US
Practice Address - Phone:410-938-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPPARD PRATT HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13-002283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD165800002Medicaid
MD165800002Medicaid