Healthcare Provider Details

I. General information

NPI: 1386042737
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND MEDICAL CENTER, OATS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST ROOM 122
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST ROOM 122
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-1057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name: MIKE PAPA
Title or Position: MANAGER
Credential: LSCW-C
Phone: 410-328-1057