MEDICARE: UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1124981279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	29 S GREENE ST STE 502
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1504
Country	:	US
Telephone Number	:	667-214-1734
Fax Number	:	410-706-6976

Provider Business Practice Location Address
First Line	:	3419 PLUMTREE DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3805
Country	:	US
Telephone Number	:	667-214-1718
Fax Number	:	410-328-5147

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	VANENIA CROWDER
Credential	:
Telephone Number	:	667-214-1734

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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