Healthcare Provider Details

I. General information

NPI: 1497760276
Provider Name (Legal Business Name): UNIVERSITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 EDMONDSON AVE
BALTIMORE MD
21229-1506
US

IV. Provider business mailing address

PO BOX 64888
BALTIMORE MD
21264-4888
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-1700
  • Fax: 410-362-1748
Mailing address:
  • Phone: 800-889-4939
  • Fax: 301-631-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL SIEGEL
Title or Position: CHIEF MEDICAL DIRECTOR
Credential:
Phone: 410-328-1700