Provider Demographics
NPI:1366986739
Name:MARYLAND MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:MARYLAND MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-529-8334
Mailing Address - Street 1:8100 SANDPIPER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5028
Mailing Address - Country:US
Mailing Address - Phone:410-529-8334
Mailing Address - Fax:
Practice Address - Street 1:8100 SANDPIPER CIR STE 100
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5028
Practice Address - Country:US
Practice Address - Phone:410-529-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034931207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty