Healthcare Provider Details

I. General information

NPI: 1528828811
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND ST. JOSEPH ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLUMTREE RD STE 301
BEL AIR MD
21015-6044
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL STEPHEN NICHOLSON
Title or Position: AO
Credential:
Phone: 410-337-1602