1104877075 NPI number — UNIVERSITY OF MARYLAND PHYSICIANS, P.A.

Table of content: (NPI 1104877075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104877075 NPI number — UNIVERSITY OF MARYLAND PHYSICIANS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND PHYSICIANS, P.A.
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:
UNIV OF MD MED GRP - GIM
Provider Other Organization Name Type Code:
3
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:
1104877075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-8040
Provider Business Mailing Address Fax Number:
410-328-0248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-214-1515
Provider Business Practice Location Address Fax Number:
410-328-8326
Provider Enumeration Date:
05/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LINGENFELTER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
410-328-8040

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1104877075 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034460902 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 764571600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".