Provider Demographics
NPI:1689690513
Name:MARYLAND ENT CENTER, LLC
Entity type:Organization
Organization Name:MARYLAND ENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-888-9000
Mailing Address - Street 1:3333 N CALVERT ST BLDG SUITE631
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:443-552-2653
Mailing Address - Fax:410-554-2171
Practice Address - Street 1:3333 N CALVERT ST STE 360
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-554-4455
Practice Address - Fax:410-554-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD563200500Medicaid
MD080MMedicare ID - Type Unspecified
MD563200500Medicaid