Healthcare Provider Details

I. General information

NPI: 1316021355
Provider Name (Legal Business Name): U M FDSP ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W. BALTIMORE ST. 7-NORTH
BALTIMORE MD
21201-1586
US

IV. Provider business mailing address

650 W. BALTIMORE ST. 7 NORTH
BALTIMORE MD
21201-1586
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7936
  • Fax: 410-706-6115
Mailing address:
  • Phone: 410-706-7936
  • Fax: 410-706-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number182
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4626
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN BASILE
Title or Position: DIRECTOR
Credential: PHD
Phone: 410-706-7936