1. Question 1: This field contains your physician's license
number and your name.
2. Question 2: Enter
the NPI number assigned to you individually.
If you do not have an NPI, mark that option.
3. Question 3: Email address is vital
for communication between you and the Board. Having
a current and accurate email address allows the Board to maintain real-time
communications with you.
4. Question 4: Enter changes to either your public or your
non-public address. The public address appears on your profile, which is
available at the Board's website on the Internet. The non-public address is
confidential and is used by the Board to correspond with you. You are required
to provide a public address. You may
also provide a non-public address.
If you provide only a non-public address, this address will also be made
available to the public.
5. Question 6: You must answer all parts of question 6,
regarding character and fitness. If you answer "yes" to any question, you must
enter an explanation at the prompt.
6. Question 10 asks whether you are in a postgraduate residency
or fellowship program. If you answer
yes, you will skip questions 15 through 26 since these items ask for more
detailed information about your patient care practice.
7. Question 13a asks for an estimate of the number of hours a
physician spends on patient care related activities. If you answer 0 hours for patient
care related activities, you will skip questions 15 through 20.
8. The Health Information Technology section is new this year. The data collected will be used by the MHCC for
9. Question 27/28:
Physician Emergency Contact Information: As part of Maryland's emergency
preparedness efforts, the Department of Health and Mental Hygiene has identified
the need for contact information on licensed physicians in Maryland. Please
include this information on the page headed "Physician Emergency Contact
Information." (Public Safety Article, Section 14-3A-01 et seq. and Health
General Article, §18-901 et seq. set forth the powers of the Governor and
Secretary of the Department of Health and Mental Hygiene.)
10. Question 29: Certification and Authorization:
By checking boxes a, b, and c, you are certifying and affirming your renewal
application. If you check box d, you
will be able to view your application online between the date you submit your
application and September 30, 2017.
11. Question 30: Enter your electronic signature, including your
name (as shown on your physician license) and the last 4 digits of your Social
Security Number. Your license will not be renewed unless all questions are
answered and the renewal application has been electronically signed.
12. Question 31: Choose a payment option. If you choose to pay via credit card,
you will need to complete all of the information on the drop-down form.
13. Once you enter a payment option and press submit, you will
see a screen confirming completion of the renewal and providing a Certificate of
Completion and Payment Receipt. If
you indicated that you or a third party would send a check, you must
print out the receipt and include it when
you submit a check. Write your
name and license number on your check to avoid delays.
Additional Information for
Options Available to Physicians with Active Licenses
- Inactive Status: If you do not plan to practice medicine in Maryland
after September 30,
2017, but wish to place your license on "Inactive Status", you may apply
during the renewal period. You may obtain an inactive status application
from the Board's website at http://www.mbp.state.md.us/pages/forms.html. Complete the
application and submit it, with a check or money order for $50 payable to the Maryland
Board of Physicians before your license expires. You may
not practice medicine, prescribe medication, or conduct peer reviews of other physicians
if your license status is inactive. If you wish to practice in Maryland in the future,
you will be required to reinstate your license.
- Voluntary non-renewal of license: If you will not be practicing
medicine at all after September 30, 2017, you may elect not to renew your
license. If you do not want to renew your license, you do not need to do
anything with this renewal application. If you wish to practice in Maryland in
the future, you will be required to reinstate your license.
- Exemption from license fee: If you will
be providing medical services to patients without personal remuneration, will
not be engaged in the private practice of medicine, and will not write
prescriptions for yourself, your family, or your friends, you may qualify for
exemption from license fee. You must obtain an "Application for Exemption from
License Fees" form (available at www.mbp.state.md.us) and follow the directions
on that form.