SHORE HEALTH SYSTEM, INC (NPI# 1548771249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548771249 |
| Entity Type | Organization |
| Organization Name | SHORE HEALTH SYSTEM, INC |
| Other Organization Name | SHORE MEDICAL PAVILION AT QUEENSTOWN |
| Practice Address |
125 Shoreway Drive Suite 130 Queenstown MD 21658 |
| Practice Telephone | 4108273811 |
| Practice Fax Number | 4108273156 |
| Mailing Telephone | 4108273811 |
| Mailing Fax Number | 4108273156 |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2017-10-20 |
| Authorized Official Name | KENNETH D KOZEL (PRESIDENT & CEO) |
| Authorized Official Telephone | 4108221000 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHORE HEALTH SYSTEM, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QS1200X |
Clinic/Center Specialization: Sleep Disorder Diagnostic |
Ambulatory Health Care Facilities | ||
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shore Medical Pavilion at Queenstown | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699286401 | Shore Health System, Inc | Clinic/Center | 10 Martin Ct Ste 100, Easton, MD 21601-4095 | 2017-10-19 |
| 1659899763 | Shore Health System, Inc | Clinic/Center | 1140 Blades Farm Road, Ste 102, Denton, MD 21629-3459 | 2017-09-08 |
| 1477513273 | Shore Health System, Inc | Clinical Medical Laboratory | 10 Martin Ct, Easton, MD 21601-3833 | 2006-03-24 |
| 1770184558 | Shore Health System, Inc | Clinical Medical Laboratory | 300 Byrn St, Cambridge, MD 21613-1908 | 2020-11-06 |
| 1396366845 | Shore Health System, Inc | Clinic/Center | 10 Martin Ct, Easton, MD 21601-4095 | 2020-05-06 |
| 1710283569 | Shore Health System, Inc | Clinic/Center | 509 Idlewild Ave, Easton, MD 21601-3889 | 2011-01-26 |
| 1790860237 | Shore Health System, Inc | Dietitian, Registered | 219 S Washington St, Easton, MD 21601-2913 | 2006-10-25 |
| 1447210463 | Shore Health System, Inc | Clinic/Center | 10 Martin Ct, Easton, MD 21601-3833 | 2006-03-24 |
| 1396705182 | Shore Health System, Inc | Skilled Nursing Facility | 219 S Washington St, Easton, MD 21601-2913 | 2006-03-24 |
| 1285694091 | Shore Health System, Inc | Psychiatric Unit | 300 Byrn St, Cambridge, MD 21613-1908 | 2006-03-24 |
| Street Address |
125 SHOREWAY DRIVE SUITE 130 |
| City | QUEENSTOWN |
| State | MD |
| Zip Code | 21658 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164684965 | Timothy Mackey Klepper | Family Medicine | 125 Shoreway Drive, Suite 120, Queenstown, MD 21658-1681 | 2008-07-02 |
| 1730440165 | Bethany Lynn Berger | Nurse Practitioner | 125 Shoreway Drive, Suite 120, Queenstown, MD 21658 | 2012-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396306916 | Andrea Lynn Shafer | Nurse Practitioner | Maryland Primary Care Physicians 125 Shoreway Dr, Ste 120, Queenstown, MD 21658 | 2019-06-25 |
| 1710206321 | Daniel Lamphier | Family Medicine | 125 Shoreway Dr Ste 120, Queenstown, MD 21658 | 2010-05-21 |
| 1881757052 | Queenstown Volunteer Fire Company | Ambulance | 7110 Main St., Queenstown, MD 21658 | 2006-12-19 |
| 1457459216 | Kathleen Stephanie Van Fossen | Social Worker | 206 Del Rhodes, Ste 203, Queenstown, MD 21658 | 2006-09-20 |
| 1265579353 | Queenstown Volunteer Fire | Ambulance | 7110 Main St., Queenstown, MD 21658 | 2007-01-30 |
| 1619075496 | Sallie Miller | Social Worker | 206 Del Rhodes, Suite 203, Queenstown, MD 21658 | 2006-09-20 |
| 1568581957 | Nicole Williams | Speech-Language Pathologist | 6923 Main St, Queenstown, MD 21658-1219 | 2007-03-28 |
| 1437123999 | Justin Scott Marlett | Specialist | 223 Melvin Ave, Queenstown, MD 21658-1237 | 2006-02-13 |
| 1871587568 | Juanita Belle Bauman | Family Medicine | 317 Overlook Drive, Queenstown, MD 21658-1262 | 2005-09-08 |
| 1326281536 | Kevin Scott Cameron | Social Worker | 101 Edge Knol Ln, Queenstown, MD 21658-1341 | 2009-04-17 |
| Find all providers in zip 21658 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134605009 | The Center for Conception and Pelvic Surgery, Inc | Clinic/Center | 3202 Tower Oaks Blvd Ste 370b, Rockville, MD 20852 | 2018-07-13 |
| 1699286401 | Shore Health System, Inc | Clinic/Center | 10 Martin Ct Ste 100, Easton, MD 21601-4095 | 2017-10-19 |
| 1659899763 | Shore Health System, Inc | Clinic/Center | 1140 Blades Farm Road, Ste 102, Denton, MD 21629-3459 | 2017-09-08 |
| 1013323799 | Chesapeake Radiology of Bel Air | Clinic/Center | 2108 Emmorton Rd, Suite 8, Bel Air, MD 21015-6800 | 2014-07-02 |
| 1750688453 | First Imaging Center Inc | Clinic/Center | 8860 Columbia 100 Pkwy Suite 10, Columbia, MD 21045-2195 | 2011-02-16 |
| 1710088075 | Metropolitan Radiology Associates Chartered | Clinic/Center | 3327 Superior Lane, Suite 103, Bowie, MD 20715 | 2006-09-26 |
| 1518075753 | American Diagnostic Medicine | Clinic/Center | 7235 Hanover Pkwy, Suite A & B, Greenbelt, MD 20770-3601 | 2006-08-28 |
| 1427071604 | Affiliated Pet Systems LLC | Clinic/Center | 1400 Forest Glen Rd Ste 430, Silver Spring, MD 20910-1464 | 2006-07-26 |
| 1447283536 | Vymed Diagnostic Imamaging/salisbury LLC | Clinic/Center | 200 B East Vine Street, Salisbury, MD 21804 | 2006-07-09 |
| 1598702870 | Open Mri & Imaging Center of Elkton,llc | Clinic/Center | 301 Augustine Herman Hwy, Ste A, Elkton, MD 21921-6587 | 2006-06-02 |
| Find all providers with the same taxonomy | ||||
| City | QUEENSTOWN |
| Zip Code | 21658 |
Please comment or provide details below to improve the information on SHORE HEALTH SYSTEM, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.