Healthcare Provider Details

I. General information

NPI: 1710821129
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S GREENE ST STE GS104A
BALTIMORE MD
21201-1504
US

IV. Provider business mailing address

116 DEFENSE HWY STE 100
ANNAPOLIS MD
21401-7040
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1734
  • Fax: 410-706-6976
Mailing address:
  • Phone: 667-214-1718
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VANENIA CROWDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 667-214-1734