Maryland Medical Practice Startup Costs in 2026
Maryland has a robust healthcare market with two major academic medical centers (Johns Hopkins, University of Maryland) anchoring the ecosystem. The DC metro northern suburbs (Montgomery, Prince George's counties) are highly competitive markets for primary and specialty care. Here are the startup costs.
Licensing and Credentialing: $2,500–$10,000
Maryland Medical License: $496 application fee (Maryland Board of Physicians). DEA registration: $888 (3-year). MD Controlled Dangerous Substance registration: $93/yr. Maryland CRNP (nurse practitioner) license: $148 initial if applicable. Malpractice insurance: $9,500–$28,000/yr depending on specialty (MSMS data). Hospital credentialing (if needed): 90–150 days. NPI: free. Medicare enrollment: free, 45–90 days. Total first-year compliance: $2,500–$10,000.
Commercial Lease: $2,200–$9,000/Month
Medical office space in Montgomery County: $28–$45/sq ft/yr (JLL DC Metro Q4 2025). Baltimore City: $20–$30/sq ft. Columbia/Howard County: $22–$32/sq ft. Annapolis: $20–$28/sq ft. A 1,400 sq ft primary care suite in Rockville: $3,267–$5,250/month. Build-out: $70–$130/sq ft for medical office. Maryland landlords often offer TI allowances of $30–$55/sq ft on 7+ year leases in suburban markets.
Equipment: $60,000–$350,000
Exam tables (4–6): $2,400–$15,000. EHR/EMR (Epic, Athena, eClinicalWorks): $8,000–$28,000 setup + $400–$900/mo. Digital X-ray: $25,000–$85,000. Lab analyzers (CBC, metabolic panel): $12,000–$35,000. EKG: $2,000–$6,000. Ultrasound (point-of-care): $15,000–$65,000. PM and billing software: $4,000–$10,000. Medical billing: 4–8% of collections if outsourced to Maryland MGMA-affiliated firms.
Workforce: $70,000–$185,000/Year
Maryland RN salary: $72,000–$95,000/yr (BLS 2025). Medical assistant: $38,000–$52,000. Front desk/patient coordinator: $38,000–$52,000. Practice administrator: $65,000–$90,000. Maryland minimum wage: $15.00/hr (2026). Maryland FAMLI paid leave program active — employer contributions required. Benefits add 28–35% to base salary in Maryland.
Total Startup Ranges
Solo primary care (Silver Spring/Rockville, 4 exam rooms): $260,000–$520,000. Specialty practice (dermatology, orthopedics): $500,000–$1,100,000. Multi-provider group practice (Montgomery County): $1,000,000–$2,500,000. Sources: Maryland Board of Physicians, JLL DC Metro Q4 2025, Maryland Medical Society.