Healthcare Provider Details

I. General information

NPI: 1114871050
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND NEUROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 NORTH EUTAW STREET SUITE 209
BALTIMORE MD
21264-0001
US

IV. Provider business mailing address

PO BOX 64526
BALTIMORE MD
21264-4526
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-4323
  • Fax: 410-328-1149
Mailing address:
  • Phone: 410-328-4323
  • Fax: 410-328-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KATELYN PETTIT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 667-214-1353