Provider Demographics
NPI:1700296969
Name:MEDSTAR FRANKLIN SQUARE MEDICAL CENTER
Entity type:Organization
Organization Name:MEDSTAR FRANKLIN SQUARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-777-6549
Mailing Address - Street 1:9000 FRANKLIN SQUARE DR
Mailing Address - Street 2:DEPT. OF FAMILY MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3901
Mailing Address - Country:US
Mailing Address - Phone:443-777-2000
Mailing Address - Fax:443-777-2034
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:DEPT. OF FAMILY MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-2000
Practice Address - Fax:443-777-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty