Organization
IDF-TRINITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZEKE AYELE (DIRECTOR OF INFORMATION SYSTEMS)
(410) 468-0900
Entity
Organization
Contact information
Practice address
3000 N RIDGE RD, ELLICOTT CITY, MD 21043-3311
(410) 468-0900
(410) 468-0911
Mailing address
840 HOLLINS ST, BALTIMORE, MD 21201-1024
(410) 468-0900
(410) 468-0911
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2560
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005759000
—
WV
01
—
0125608
AETNA
MD
05
—
01689292
—
PA
01
—
0704865003
CIGNA
MD
01
—
21506
JAI MEDICAL
MD
01
—
215143
MDIPA
MD
01
—
590080-01
CAREFIRST
MD
01
—
PS7
FEP
MD
Enumeration date
08/04/2006
Last updated
08/22/2020
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