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:
Telehealth Services Regulations COMAR 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

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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