Healthcare Provider Details

I. General information

NPI: 1437102035
Provider Name (Legal Business Name): CENTRAL MARYLAND UROLOGY ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR 130
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

10710 CHARTER DR 130
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-7000
  • Fax: 410-772-7072
Mailing address:
  • Phone: 410-772-7000
  • Fax: 410-772-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0032691
License Number StateMD

VIII. Authorized Official

Name: DR. MARC B APPLESTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-772-7000