Healthcare Provider Details

I. General information

NPI: 1104735224
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND NEUROSURGERY ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W CAMDEN ST FL 6
BALTIMORE MD
21201-2473
US

IV. Provider business mailing address

PO BOX 64315
BALTIMORE MD
21264-4315
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6034
  • Fax: 410-328-0756
Mailing address:
  • Phone: 410-328-8209
  • Fax: 410-328-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VANCE CRESIC
Title or Position: DIRECTOR
Credential:
Phone: 667-225-3010