Healthcare Provider Details

I. General information

NPI: 1720829245
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DR STE 119
GLEN BURNIE MD
21061-5706
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8240
  • Fax: 410-553-8239
Mailing address:
  • Phone: 443-462-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

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