Provider Demographics
NPI:1952333882
Name:THE MARYLAND CENTER FOR DIGESTIVE HEALTH LLC
Entity Type:Organization
Organization Name:THE MARYLAND CENTER FOR DIGESTIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARSHA
Authorized Official - Last Name:BOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-837-2011
Mailing Address - Street 1:820 BESTGATE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-2118
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3404
Practice Address - Country:US
Practice Address - Phone:410-224-2116
Practice Address - Fax:410-224-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1065261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDZZ50Medicare UPIN
MDZZ50Medicare PIN