Healthcare Provider Details

I. General information

NPI: 1508065178
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST 2ND FLOOR
BALTIMORE MD
21223-2682
US

IV. Provider business mailing address

PO BOX 62498
BALTIMORE MD
21264-2498
US

V. Phone/Fax

Practice location:
  • Phone: 717-428-0552
  • Fax: 717-428-0518
Mailing address:
  • Phone: 717-428-0552
  • Fax: 717-428-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number903649
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number14303
License Number StateMD

VIII. Authorized Official

Name: GEORGE SPRINKEL
Title or Position: CFO
Credential:
Phone: 410-328-1501