Healthcare Provider Details

I. General information

NPI: 1588023667
Provider Name (Legal Business Name): MDICS AT UMROI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
GWYNN OAK MD
21207
US

IV. Provider business mailing address

PO BOX 69231
BALTIMORE MD
21264-9231
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax: 443-949-0825
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-949-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM DELBRUGGE
Title or Position: CFO
Credential:
Phone: 301-693-8707