1659304152 NPI number — UNIVERSITY OF MARYLAND DERMATOLOGISTS PA

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 1659304152 NPI number — UNIVERSITY OF MARYLAND DERMATOLOGISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
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:
1659304152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64445
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:
21264-4445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-5767
Provider Business Mailing Address Fax Number:
410-328-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5890 WATERLOO RD STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-3167
Provider Business Practice Location Address Fax Number:
410-328-1323
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMERMAN
Authorized Official First Name:
KAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
410-328-5767

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S045 . This is a "BLUE SHIELD FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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