Healthcare Provider Details

I. General information

NPI: 1811704208
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND EMERGENCY MEDICINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE
BALTIMORE MD
21201-4606
US

IV. Provider business mailing address

PO BOX 73276
BALTIMORE MD
21273-3276
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-8103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAVONDA L WILLIAMS
Title or Position: CORPORATE DIRECTOR
Credential:
Phone: 667-214-2507