MEDICARE: UNIVERSITY OF MARYLAND NEUROSURGERY ASSOCIATES P A

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1386519734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND NEUROSURGERY ASSOCIATES P A

Provider Business Mailing Address
First Line	:	PO BOX 64315
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4315
Country	:	US
Telephone Number	:	410-328-8209
Fax Number	:	410-328-1413

Provider Business Practice Location Address
First Line	:	9300 LOTTSFORD RD
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-4886
Country	:	US
Telephone Number	:	410-328-8209
Fax Number	:	410-328-1413

Authorized Official
Title or Position	:	REIMBURSEMENT OPS CREDENTIALING SPE
Name	:	KATELYN PETTIT
Credential	:
Telephone Number	:	667-214-1353

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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