Healthcare Provider Details

I. General information

NPI: 1164426045
Provider Name (Legal Business Name): ANNE ARUNDEL UROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 222&223
ANNAPOLIS MD
21401-1001
US

IV. Provider business mailing address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax: 410-266-8054
Mailing address:
  • Phone: 410-266-8049
  • Fax: 410-266-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARA HOLTON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 410-266-8049