Basic Information
| Provider Information | |||||||||
| NPI: | 1790867802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS AFFAIRS MARYLAND HEALTH CARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 N HOWARD ST | ||||||||
| Address2: | APT 601 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105288945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 N GREENE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPYIES | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
| AuthorizedOfficialMiddleName: | BRANDILYN | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR OF CLINICAL AUDIOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 4106057000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | AU.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 01116 | MD | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.