Healthcare Provider Details

I. General information

NPI: 1477530624
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 443-552-2900
  • Fax:
Mailing address:
  • Phone: 443-462-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL STEPHEN NICHOLSON
Title or Position: SENIOR VICE PRESIDENT - CHIEF FINAN
Credential: CPA
Phone: 410-822-1000