Healthcare Provider Details

I. General information

NPI: 1336404110
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N HAMMONDS FERRY RD STE C
LINTHICUM HEIGHTS MD
21090-1355
US

IV. Provider business mailing address

825 N HAMMONDS FERRY RD STE C
LINTHICUM HEIGHTS MD
21090-1355
US

V. Phone/Fax

Practice location:
  • Phone: 443-462-3508
  • Fax: 410-296-3207
Mailing address:
  • Phone: 443-462-3508
  • Fax: 410-296-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC15150
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC15150
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JON BURNS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 443-462-3508