Basic Information
| Provider Information | |||||||||
| NPI: | 1972774925 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE GOOD SAMARITAN HOSPITAL OF MD, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | JOHNS HOPKINS ORTHOPAEDICS AT GSH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING, SUITE G-1 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434444517 | ||||||||
| FaxNumber: | 4434444752 | ||||||||
| Practice Location | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING, SUITE G-1 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434444517 | ||||||||
| FaxNumber: | 4434444752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILHELM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | SERVICE LINE DIRECTOR - ORTHOPAEDIC | ||||||||
| AuthorizedOfficialTelephone: | 4434444517 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.