Maryland Medicaid Data Request
Please describe your data needs below at a level of technical specificity needed by the data provider who will respond to your request. Ensure that you define precisely what data are/are not needed. You may email email one or more attachments (e.g. a data dictionary or listing of targeted data elements) that provides a more granular description of the needed data to dhmh.medicaiddatarequests@maryland.gov.
Project Title: *
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Principal Investigator's (PI's) Name: *
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Street Address: *
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City, State, ZIP Code: *
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Email Address: *
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Telephone #: *
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Facsimile #:
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