1013765981 NPI number — UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013765981 NPI number — UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013765981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 ELKRIDGE LANDING RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTHICUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21090-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-553-8146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
AO
Authorized Official Telephone Number:
410-337-1602

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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