1336515519 NPI number — UNIVERSITY OF MARYLAND BALTIMORE

Table of content: (NPI 1336515519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336515519 NPI number — UNIVERSITY OF MARYLAND BALTIMORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND BALTIMORE
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:
1336515519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 W LOMBARD ST
Provider Second Line Business Mailing Address:
SUITE 425B
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-706-5395
Provider Business Mailing Address Fax Number:
410-706-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8011 NEW HAMPSHIRE AVE
Provider Second Line Business Practice Location Address:
MOBILE UNIT
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20783-4612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-228-9668
Provider Business Practice Location Address Fax Number:
410-706-5145
Provider Enumeration Date:
08/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ANTOL
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
410-706-5395

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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