Healthcare Provider Details

I. General information

NPI: 1942368162
Provider Name (Legal Business Name): STATE OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 CAMPUS DRIVE UNIVERSITY OF MARYLAND
COLLEGE PARK MD
20742-0001
US

IV. Provider business mailing address

3983 CAMPUS DRIVE UNIVERSITY OF MARYLAND BUILDING 140
COLLEGE PARK MD
20742-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-314-8167
  • Fax: 301-314-3677
Mailing address:
  • Phone: 301-314-8167
  • Fax: 301-314-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberP00845
License Number StateMD

VIII. Authorized Official

Name: DR. SPYRIDON MARINOPOULOS
Title or Position: DIRECTOR
Credential: MD
Phone: 301-314-8117