Healthcare Provider Details

I. General information

NPI: 1407970601
Provider Name (Legal Business Name): MARYLAND PHYSICIANS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD SUITE 205A
BALTIMORE MD
21215-2686
US

IV. Provider business mailing address

6615 REISTERSTOWN RD SUITE 205A
BALTIMORE MD
21215-2686
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2298
  • Fax: 410-358-6551
Mailing address:
  • Phone: 410-486-2298
  • Fax: 410-358-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MELENCIO VENTURA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 410-486-2298