Healthcare Provider Details

I. General information

NPI: 1033042460
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HOSPITAL DR STE 207
GLEN BURNIE MD
21061-6411
US

IV. Provider business mailing address

PO BOX 778
EASTON MD
21601-8914
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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