Healthcare Provider Details

I. General information

NPI: 1962319582
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND SPECIALTY CARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEFENSE HWY STE L101
ANNAPOLIS MD
21401-8925
US

IV. Provider business mailing address

PO BOX 69744
BALTIMORE MD
21264-9744
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-0350
  • Fax: 888-223-8242
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACY L ANDERSON
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 410-328-7007