1336404110 NPI number — UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC

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 1336404110 NPI number — UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC
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:
6
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:
1336404110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 N HAMMONDS FERRY RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTHICUM HEIGHTS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21090-1355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-462-3508
Provider Business Mailing Address Fax Number:
410-296-3207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 N HAMMONDS FERRY RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINTHICUM HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21090-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-462-3508
Provider Business Practice Location Address Fax Number:
410-296-3207
Provider Enumeration Date:
07/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
443-462-3508

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  C15150 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: C15150 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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