Basic Information
| Provider Information | |||||||||
| NPI: | 1376523357 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNION HOSPITAL OF CECIL COUNTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 106 BOW ST | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
| FaxNumber: | 4106201494 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 BOW ST | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
| FaxNumber: | 4106201494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GERACIMOS | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | TYLER | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4103927008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 07005 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01609250 | 05 | NY | MEDICAID | 470001663 | 01 | MD | RISING SUN RAILROAD | OTHER | 57350901 | 01 | MD | BCBS MD | OTHER | MC4 | 01 | MD | BC OF NCA | OTHER | 6902000000K729 | 01 | MD | COM UNITED HC | OTHER | 0004568000 | 01 | MD | BC INDEPENDANCE | OTHER | 009717 | 01 | MD | AETNA | OTHER | 24561 | 01 | MD | COVENTRY | OTHER | DD6NOP | 01 | MD | BCMD PRINCIPIO SITE LABS | OTHER | 0000220605 | 05 | DE | MEDICAID | 470001009 | 01 | MD | PERRYVILLE RAILROAD | OTHER | 6902000000KS91 | 01 | MD | COM UNITED HC | OTHER | 0000246406 | 05 | DE | MEDICAID | 235776 | 01 | MD | COMM MID ATLANTIC MED SE | OTHER | 6902000000K970 | 01 | MD | COMM UHC | OTHER | A151081 | 01 | DE | BCBS OF DE | OTHER | P00849784 | 01 | MD | MEDICARE PALMETTO | OTHER | 000385900 | 05 | MD | MEDICAID |