Healthcare Provider Details

I. General information

NPI: 1699921411
Provider Name (Legal Business Name): GEORGE E. URBAN, JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD SUITE 410
CLINTON MD
20735-2508
US

IV. Provider business mailing address

9131 PISCATAWAY RD SUITE 410
CLINTON MD
20735-2508
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-1234
  • Fax: 301-868-2751
Mailing address:
  • Phone: 301-868-1234
  • Fax: 301-868-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE EDWARD URBAN JR.
Title or Position: OWNER
Credential: MD
Phone: 301-868-1234