| Organization Name: | STATE OF MARYLAND |
| NPI Number: | 1154345981 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURENCE B POLSKY (HEALTH OFFICER) |
| Mailing Address: | 975 Solomons Island Rd N Prince Frederick |
| State: | MD US |
| Postal Code: | 206780980 |
| Phone Number: | 4105355400 |
| Fax Number: | 4105355285 |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 08/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | D50213 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |