Healthcare Provider Details

I. General information

NPI: 1013830637
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND PEDIATRIC ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 KENILWORTH DR
TOWSON MD
21204-2101
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-2200
  • Fax: 410-296-3210
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGIE I BURR
Title or Position: DIRECTOR OF REVENUE MANAGEMENT
Credential:
Phone: 410-706-5181