Healthcare Provider Details

I. General information

NPI: 1972084507
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND BALTIMORE WASHINGTON HEART ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HOSPITAL DR FL 3
GLEN BURNIE MD
21061-6356
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA PAESCH
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 410-787-4854