Application for Reinstatement of License

This application consists of five parts:

• Part 1 - General Information (Address and Contact information)
• Part 1v - Veterans, Service Information
• Part 2 - Employment Activities
• Part 3 - License History
• Part 4 - Continuing Education (CE)
• Part 5 - Character and Fitness Questions (14 questions)
• Certification and Authorization of Application
• License Fee Payment and Receipt of Completion

At the completion of the application you will be able to print out a copy of your application and receipt.

If you cannot complete the application, you may login at another time and continue. Information you completed will be saved.

Practitioner licenses consist of an alpha character followed by 7 digits. The alpha character denotes your board. For example:

• X0123456

You must use the 8 character license to verify your reinstatement eligibility status.

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If you need help finding the license number, you can search the Practitioner Profile website by name.

Identification Numbers: Maryland law requires all persons applying for professional licensure or certification to disclose a social security number (SSN) or individual taxpayer identification number (ITIN). The Maryland Board of Physicians is required by state and federal law to use the identification number for the following purposes:

1. Verification of identity with respect to actions related to your license (Code of Maryland Regulations 10.32.01.04);
2. Administration of the Child Support Enforcement Program (Family Law Article, §10-119.3);
3. Identification by the Department of Assessments and Taxation of new businesses in Maryland (Health Occupations Article, §1-210);
4. Verification by the Maryland Medicaid program of licensure and sanctions for providers participating in Medicaid [42 U.S.C. §1396a(a)(49); 42 U.S.C. §1396r-2; 42 U.S.C. §1320a-7].

If the applicant does not have an SSN or ITIN, contact mbpmail@rcn.com.

The email address provided must be for you and not office or credentialing staff. The email must be regularly used by you for correspondence with the Board. This email address is confidential and will not be shared or disclosed, except in accordance with compulsory process as defined in Section 4-306 of the Health-General Article. The Board will use this email for official correspondence.

Identification Numbers: Maryland law requires all persons applying for professional licensure or certification to disclose a social security number (SSN) or individual taxpayer identification number (ITIN). The Maryland Board of Physicians is required by state and federal law to use the identification number for the following purposes:

1. Verification of identity with respect to actions related to your license (Code of Maryland Regulations 10.32.01.04);
2. Administration of the Child Support Enforcement Program (Family Law Article, §10-119.3);
3. Identification by the Department of Assessments and Taxation of new businesses in Maryland (Health Occupations Article, §1-210);
4. Verification by the Maryland Medicaid program of licensure and sanctions for providers participating in Medicaid [42 U.S.C. §1396a(a)(49); 42 U.S.C. §1396r-2; 42 U.S.C. §1320a-7].

If the applicant does not have an SSN or ITIN, contact mbpmail@rcn.com.