Healthcare Provider Details

I. General information

NPI: 1104697366
Provider Name (Legal Business Name): ANNE ARUNDEL UROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 WALKER DR STE 100
GREENBELT MD
20770-3293
US

IV. Provider business mailing address

7855 WALKER DR STE 100
GREENBELT MD
20770-3293
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax:
Mailing address:
  • Phone: 410-266-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARA HOLTON
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 410-266-8049