Healthcare Provider Details

I. General information

NPI: 1255294328
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 LANDMARK DR
GLEN BURNIE MD
21061-4486
US

IV. Provider business mailing address

29 S GREENE ST STE 502
BALTIMORE MD
21201-1504
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1718
  • Fax: 410-706-6976
Mailing address:
  • Phone: 667-214-1734
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VANENIA CROWDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 667-214-1734