Healthcare Provider Details

I. General information

NPI: 1336404110
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 SPARROWS POINT BLVD
EDGEMERE MD
21219-1462
US

IV. Provider business mailing address

1390 SPARROWS POINT BLVD
EDGEMERE MD
21219-1462
US

V. Phone/Fax

Practice location:
  • Phone: 443-462-5850
  • Fax: 410-636-0309
Mailing address:
  • Phone: 443-462-5850
  • Fax: 410-636-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC15150
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC15150
License Number StateMD

VIII. Authorized Official

Name: DOUGLAS LASCH
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 443-462-5850