Physicians who have medical staff membership and/or clinical privileges at MedStar Good Samaritan Hospital are required to submit all licensure information to the Medical Staff Office. Licensure and professional liability insurance must be current at all times. Notify the Medical Staff Office of any change in home or office addresses, as well as telephone numbers.

At the time of any licensure or professional liability insurance renewals, the office staff should assume responsibility for forwarding the following information:

• Maryland State Licensure
• DEA (Federal Narcotics License)
• Controlled Dangerous Substances License (State of Maryland)
• Copy of current certificate of professional liability insurance

At the time of reappointment, it is important for the office staff to alert their physicians to return the reappointment application in the requested time frame. In general, any correspondence forwarded to the physician from the Medical Staff Office is important and should receive immediate attention.

The Medical Staff offices for MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital are now centrally located on the MedStar Union Memorial campus.

MedStar Union Memorial Hospital
Medical Staff Office
201 E. University Pkwy.
Baltimore, MD 21218

To obtain an application for MedStar Harbor Hospital privileges, please submit a written letter including: specialty, board certification status, and the address to which the application the address to which the application may be sent. You may mail, fax to 410-350-2027, or email your letter to carolyn.p.luther@medstar.net.

MedStar Harbor Hospital
Medical Staff Services Department
ATTN: Carolyn P. Luther
3001 South Hanover St.
Baltimore, MD 21225-1290

Physicians and Allied Health Professionals who have Medical Staff membership and/or clinical privileges at MedStar Harbor are required to submit all licensure information to the Medical Staff Services department. Licensure and professional liability insurance must be carried at all times. At the time of any licensure or professional liability insurance renewals, your office staff should assume responsibility for forwarding the following:

• Federal DEA Certificate
• State of Maryland Controlled Dangerous Substance License
• Professional Liability Insurance

Notify the Medical Staff Services department of any change in office or home addresses as well as telephone, fax numbers and email addresses.

• Download and complete the Maryland State Credentials form.
• Download and complete the MedStar Montgomery Medical Center Supplemental Application form.
• Request a Delineation of Privileges form by writing to Bethany Legrand at blegrand@medstarmontgomery.org. Please include your first and last name and your specialty. The appropriate form will be e-mailed to you within two business days.
• Once completed, mail all three forms to the mailing address below.

To obtain an application packet for privileges at MedStar Southern Maryland Hospital Center or for questions, please contact the Medical Staff Office. If the applicant meets minimum criteria as defined in the Medical Staff Bylaws, an application packet will be sent via email.

To obtain an application for MedStar St. Mary’s Hospital privileges, please contact the Medical Staff Office at MedStar St. Mary’s Hospital for an Application Request Form (ARF) and submit a copy of your CV to the Medical Staff Office.

Medical Staff Office
ATTN: Cathy Oliver
MedStar St. Mary’s Hospital
25500 Point Lookout Rd.
PO Box 527
Leonardtown MD 20650

Contact the Medical Staff Office at 301-475-6088 for more information on applying for privileges and membership.

Medical Staff Services manages credentialing and privileging for all clinical departments within MedStar Union Memorial Hospital. Our medical staff consists of more than 800 physicians and allied health professionals. MedStar Union Memorial meets all federal, state and regulatory standards for credentialing and privileging.

If you would like to discuss attaining medical privileges at our hospital, please call 410-554-2280.

Please notify the Medical Staff Services Office of changes as they occur, such as:

• Telephone and pager numbers
• Home and office addresses
• Updated licensures, malpractice coverage/issues, and special certifications
• Medical staff member status or resignation

Per the Bylaws, a Practitioner (MD, NP, Psychologist, DPM, DDS, DMD, LSCW) who wishes to apply for privileges and become a member of the Staff at MedStar Georgetown University Hospital shall establish that he or she meets the following qualifications:

• Current licensure in the District of Columbia, Maryland or Virginia, as required to render patient care services at MedStar Georgetown, or another MedStar Health hospital or one of its ambulatory care satellites.
• Diploma from a school or program approved by the Board on advice of the MEC for the Practitioner's field of practice.
• Consent from the Practitioner for inspection of all records and documents pertinent to his or her licensure, training, experience, current competency, and health status, and agreement to appear for an interview if requested.
• A pledge from the Practitioner to provide continuous care for his or her patients and to abide by the Hospital policies and Code of Conduct.
• Agreement of the Practitioner to release and waive any claim against the Hospital, its Staff members, employees, and Board members, and any other individual, institution, or agency acting at the request of the Hospital for: (i) providing information to the Hospital as part of the credentials review process; (ii) participating in the credentials review process or in a Professional Review Action; or (iii) providing information to another hospital, institution or agency in good faith, in response to a request for credentials or performance information about the Practitioner.
• Agreement of the Practitioner to comply with the Ethical Religious Directives in regard to matters involving pastoral care, patient care, care for the beginning of life, and care for the dying on the Hospital clinical campus.
• Proof of current liability insurance
• Negative drug screen and acceptable criminal background check
• Proof of current influenza vaccination (during the defined influenza period)
• Payment of a non-refundable fee to reimburse the Hospital for the expenses incurred in the receipt and review of the application.

Staff membership shall not be denied to a Practitioner on the basis of gender, gender identity, gender expression, sexual preference, sexual orientation, race, ethnic/national identity, language, culture, color, creed, national origin, age, marital status, religion, socioeconomic status, type of procedure or patient in which the provider specializes in, and/or physical or mental disability unrelated to the effective delivery of patient care at the generally recognized professional level of competence.

MedStar Georgetown utilizes the electronic CAQH application. In order to obtain additional required forms or for questions, please contact the Medical Staff Affairs Office at 202-444-3011.

The mailing address is:
MedStar Georgetown University Hospital
Office of Medical Staff Affairs
3800 Reservoir Rd. NW
Lower Level Bles Room 144
Washington, D.C., 20007

Initial appointment

To obtain an application for initial appointment at MedStar National Rehabilitation Network, please submit a written letter including specialty to:

Medical Staff Administration
Attn: Peggy Thomas
102 Irving Street, NW
Washington, D.C.,  20010
Email: peggy.thomas@medstar.net

We accept CAQH uniform application for initial appointment. Please contact the Medical Staff Administration office at 202-877-1156 for more information on applying for privileges.

By email - Send the completed form to debbi.l.mister@medstar.net

By fax - Fax the completed form to 202-877-0876

By mail - Send the completed form to:
Credentialing Department
ATTN: Karin
110 Irving St., NW
POB 121
Washington, D.C., 20010