1679309447 NPI number — UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA

Table of content: (NPI 1679309447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679309447 NPI number — UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, 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:
1679309447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62063
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:
21264-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-706-5181
Provider Business Mailing Address Fax Number:
410-706-5103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 MONTEVUE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-8214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6749
Provider Business Practice Location Address Fax Number:
410-328-7305
Provider Enumeration Date:
09/10/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BURR
Authorized Official First Name:
MARGIE
Authorized Official Middle Name:
OLLER
Authorized Official Title or Position:
DIRECTOR OF PROFESSIONAL FEES
Authorized Official Telephone Number:
410-706-5181

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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