Maryland Medical Programs Web Services
... brought to you by the Maryland Department of Health
Enroll as a temporary Maryland Medicaid provider for COVID-19 state of emergency
This platform should only be used by providers who are serving Maryland Medicaid participants during the COVID-19 state of emergency. This is ONLY for NEW, individual provider use. If you are enrolling a group or facility, email mdh.providerenrollment@maryland.gov for more information.
To enroll as a permanent Medicaid provider (i.e. during and beyond the state of emergency), please submit a new enrollment application through ePREP (eprep.health.maryland.gov).
Before beginning the application process, please provide the following information:
(As the person completing this form, you are required to enter your own name and contact information. Do not enter the Provider's name unless you yourself are the Provider.)
Your First Name:
Your Last Name: 
Your Phone Number:  - - ext.
Your Job Title:
Your relationship to the Provider who is applying:
I am the provider.
I am an employee of the Provider.
I am not an employee, but I am an
authorized representative of the Provider.
To begin the application process, please select the Provider Type which corresponds to the type of healthcare services that you provide:

If you do not see your Provider Type in this list, please contact mdh.providerenrollment@maryland.gov.
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