Get Maryland Uniform Credentialing Form 2020-2025

Completing the Maryland Uniform Credentialing Form online is essential for healthcare providers seeking to practice in Maryland. This guide provides a detailed, step-by-step approach to filling out the form correctly and efficiently.

Follow the steps to fill out the Maryland Uniform Credentialing Form online.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by carefully reading all instructions provided at the top of the form to understand the requirements.
3. In Section 1, enter your provider type and full legal name, avoiding nicknames or initials unless they are part of your legal name.
4. Provide personal information including last name, first name, and any other name you have used, ensuring all required fields marked with an asterisk (*) are completed.
5. Fill in your professional IDs, including any relevant state licenses, DEA Registration, and CDS certification numbers if applicable.
6. Complete the education and training sections, listing all institutions and degrees obtained, and use the associated code lists if necessary.
7. In Section 3, provide information about your primary and secondary specialties, making sure to indicate if you are board certified.
8. Complete the practice location information, including billing contacts and acceptance of new patients, in Section 4.
9. Discuss any gaps in work history if applicable in Section 7 and provide required explanations.

Start filling out the Maryland Uniform Credentialing Form online today to ensure a smooth application process.