Provider Demographics
NPI:1144298290
Name:STATE OF MARYLAND - DHMH
Entity type:Organization
Organization Name:STATE OF MARYLAND - DHMH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MSN
Authorized Official - Phone:410-228-3223
Mailing Address - Street 1:3 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2362
Mailing Address - Country:US
Mailing Address - Phone:410-228-3223
Mailing Address - Fax:410-901-8195
Practice Address - Street 1:3 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2362
Practice Address - Country:US
Practice Address - Phone:410-228-3223
Practice Address - Fax:410-901-8195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MARYLAND - DHMH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD505593800Medicaid
MD505593800Other505593800
MDDB9417OtherPALMETTO GBA RAILROAD GRO
MDVA05I256Medicare PIN
MDDB9417OtherPALMETTO GBA RAILROAD GRO
MD505593800Other505593800
MDB85880Medicare UPIN
MD135953ZBFKMedicare PIN