Telehealth Distant Site Registration Form
For your reference and review, you may click the links for guidance before starting the registration process:
Telehealth Provider Manual on the Maryland Medicaid Telehealth Program webpage:
https://mmcp.health.maryland.gov/Pages/telehealth.aspx
Telehealth Services Regulations COMAR 10.09.49
http://www.dsd.state.md.us/COMAR/SubtitleSearch.aspx?search=10.09.49.*
Please select from the options below to start your Maryland Medicaid Telehealth Registration
If you have questions before beginning the registration, please email mdh.telemedicineinfo@maryland.gov


The Telehealth team shares telehealth updates via email. Please provide a contact person's information to best share these updates.

Telehealth Contact's Name
Your answer
Telehealth Contact's Phone Number:
Your answer
Telehealth Contact's Email Address:
Your answer
If you would like to have your contact information shared with other Telehealth registered providers, please select yes.
Do you have an existing telehealth partner?
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