Healthcare Provider Details

I. General information

NPI: 1386074318
Provider Name (Legal Business Name): US MEDGROUP OF NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 KNECHT AVE
BALTIMORE MD
21227-1415
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST TOWER
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-9595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HASSETT
Title or Position: PRESIDENT
Credential: DO
Phone: 972-364-8000