Healthcare Provider Details

I. General information

NPI: 1902252067
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND DEPARTMENT OF RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST N2E17
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST N2E17
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-7324
  • Fax:
Mailing address:
  • Phone: 410-328-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MCCOY
Title or Position: PHYSICIAN PARTNER/MANAGER
Credential:
Phone: 410-328-7324