Healthcare Provider Details

I. General information

NPI: 1912793589
Provider Name (Legal Business Name): UNIVERSITY OF MD OBSTETRICAL AND GYNECOLOGICAL ASSO. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 UPPER CHESAPEAKE DR STE 518
BEL AIR MD
21014-4332
US

IV. Provider business mailing address

250 W PRATT ST STE 880
BALTIMORE MD
21201-6829
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1300
  • Fax: 410-328-3379
Mailing address:
  • Phone: 667-214-1301
  • Fax: 410-328-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICK BRINEGAR
Title or Position: DIRECTOR
Credential:
Phone: 667-214-1301