Healthcare Provider Details

I. General information

NPI: 1952739500
Provider Name (Legal Business Name): PARTNERMD MARYLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PARK CENTER CT SUITE 200
OWINGS MILLS MD
21117-5623
US

IV. Provider business mailing address

9 PARK CENTER CT SUITE 200
OWINGS MILLS MD
21117-5623
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-2655
  • Fax: 804-672-4948
Mailing address:
  • Phone: 804-282-2655
  • Fax: 804-672-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES DAVID MUMPER
Title or Position: MD
Credential: MD
Phone: 804-282-2655