Healthcare Provider Details

I. General information

NPI: 1295541894
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LINDEN AVE
BALTIMORE MD
21201-4622
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 443-682-6800
  • Fax: 410-225-8395
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGIE OLLER BURR
Title or Position: DIRECTOR OF PROFESSIONAL FEES
Credential:
Phone: 410-706-5181