Provider Demographics
NPI:1194788513
Name:MARYLAND DIGESTIVE DISEASE CENTER
Entity type:Organization
Organization Name:MARYLAND DIGESTIVE DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-498-5500
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5263
Mailing Address - Country:US
Mailing Address - Phone:301-498-5500
Mailing Address - Fax:301-498-7346
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:410-730-9363
Practice Address - Fax:410-730-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213681300Medicaid
MD0920MAOtherCAREFIRST BCBS MD
DCA111OtherCAREFIRST BCBS DC
MD213681301Medicaid
MD213681301Medicaid